June 21st, 2010 by EvanFalchukJD in Better Health Network, Health Policy, News, Opinion
1 Comment »
The Senate has rejected the so-called “doc fix.” This means that doctors taking Medicare patients will now get 21 percent less pay for their work.
How’s that getting involved in politics working out for you guys? Not so good.
But there’s a larger issue here. Why do we keep trying to control healthcare costs by just mandating that less money be spent?
It’s failed for decades. But like a losing gambler convinced that if he just keeps doubling down he’ll finally come out ahead, people keep trying. For example, the New York Times reported on a study of the impact of pay cuts to doctors for Medicare patients with lung cancer. Read more »
*This blog post was originally published at See First Blog*
June 9th, 2010 by Richard Cooper, M.D. in Better Health Network, Health Policy, News, Opinion, Research
No Comments »
In a recent blog posting, I described Group Health’s medical home for 8,000 patients. It proved to be a boon for primary care physicians, who were able to reduce the size of their patient panels, see fewer patients per day, refer more patients to specialists, and maintain or increase their incomes.
Patients liked it, too. And Group Health was happy because expenditures per patient were 2 percent lower. But poor patients had trouble getting through the front door of the medical home, so based on demographic differences alone, expenditures should have been lower by 10 percent or more. Nonetheless, they declared victory.
Now news filters south from Ontario’s eight-year experiment with medical homes for 8,000,000 patients, and the news is similar. Participation is skewed to healthier and wealthier patients who, in the absence of risk adjustment, yield profitable capitation for primary care physicians. Incomes have soared an average of 25 percent. Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
June 2nd, 2010 by KevinMD in Better Health Network, Health Policy, News, Opinion, Research, True Stories
1 Comment »
How much is a primary care appointment worth? Not much, it appears.
Physicians in California decided to embark on an innovative idea, asking patients to simply pay them what they thought the visit was worth. Here’s how it worked:
On the day of the events, no insurance was accepted. Care was provided only to the uninsured, who were asked to pay what they could afford. Laboratory tests were provided at cost, and patients who needed additional services were referred to various public resources. Practices also handed out lists of generic medications available for reduced prices at large, discount pharmacies.
Physicians who accept Medicare are not allowed to include Medicare beneficiaries in any pay-what-you-can program.
Although patients did value the visit, they grossly underestimated its cost. Read more »
*This blog post was originally published at KevinMD.com*
May 24th, 2010 by Shadowfax in Better Health Network, Health Policy, News, Opinion
2 Comments »
There’s just so much hidden and buried in the Affordable Care Act (ACA) that it’s like trying the find all the goodies in an Easter egg hunt. ACEP News pointed out one hidden goodie, nicely illustrated in this article from Kaiser Health News:
Under the new health law, insurance companies must extend several new protections to patients who receive emergency care. One of the biggest guarantees: Patients who need emergency treatment will have their costs covered at the same rate, regardless of whether they are treated at “in-network” or “out-of-network” hospitals.
The law also bars health plans from requiring prior authorization for emergency services. And it mandates that plans follow the “prudent layperson” rule. For example, if a person goes to the ER with chest pain, but ends up being diagnosed with indigestion, the claim has to be covered because going to the hospital under those circumstances made sense.
The provisions go into effect for every health plan issued after Sept. 23 – six months after the law was enacted — that offers emergency coverage.
This is potentially quite significant. As with so many things, the devil is in the details, and the implementation is not yet actualized. Read more »
*This blog post was originally published at Movin' Meat*
May 17th, 2010 by Happy Hospitalist in Better Health Network, Health Policy, Opinion, True Stories
No Comments »
The essence of the moral hazard experience through a nice neighborly conversation:
Neighbor: These allergies are killing me.
Happy: That’s terrible. I hope you feel better.
Neighbor: I tried Zyrtec but it wasn’t doing anything for me, so my doctor prescribed ‘x.’ (inaudible drug name )
Happy: Does it start with an ‘x?’ (The drugs name is Xyzal.)
Neighbor: Yes, it does.
Happy: Oh, that drug (Xyzal) is nothing more than Zyrtec, which the company slightly changed the formula of and now they get to sell it as a patented medication at 10 times the price for the next 10 years.
Neighbor: Oh, I didn’t know that. But you’re right. It was $110.
Happy: Did it help you with your allergies?
Neighbor: Nope.
Happy: I guess you just wasted $100.
Neighbor. I didn’t waste anything. My insurance company paid for it.
Happy: Actually, we all paid for it with higher premiums.
Neighbor: (Walks away.)
The doctor doesn’t care — he’s not paying for it. The patient doesn’t care — she’s not paying for it. But everyone complains that their insurance rates are out of control. It’s not insurance company profits that are making healthcare too expensive, it’s patients and doctors who don’t care.
Bundled care solves this problem because the doctor won’t prescribe a $110 medication and offer therapies with no proven benefit over less-expensive options.
*This blog post was originally published at The Happy Hospitalist*
