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Un-Insurance Reform

Who doesn’t need insurance reform? Why, the insurers like Aetna, Cigna, and BCS Insurance, that’s who! From Emergency Physicians Monthly:

By threatening to raise health care premiums by 200 percent or threatening to drop coverage altogether, the companies got the Department of Health and Human Services to cave. Now the companies have our government’s blessing to continue offering “insurance” to their employees that is capped at a few thousand dollars per year instead of the $750,000 required in the health care law.

Perhaps GruntDoc said it best:

“I am not an Obamacare fan, and would like it repealed, with smaller, more focused Bipartisan fixes, but if the government is going to pass something then roll over this easily to special interests… it’s already worse than useless.”

-WesMusings of a cardiologist and cardiac electrophysiologist.

*This blog post was originally published at Dr. Wes*

In The News: Political Doctors, Antibiotic Resistance, And Stem Cell Research

Medical organizations are donating heavily to doctors running for the U.S. House. Dentists, ophthalmologists, radiologists, surgeons, neurologists and ENTs have contributed heavily. The goal is to get doctors onto committees where they can have the most impact. So far, the candidates have trended heavily Republican and have, in at least one campaign, vowed to overturn healthcare reform. The stakes are high if opposing legislators succeed, because they could underfund or block portions of reform to the point that it works poorly or not at all. (Politico, New England Journal of Medicine)

Spurred by antibiotic resistance seen in almost every drug class, FDA Commissioner Margaret Hamburg, FACP, is turning the agency’s attention toward animal feed. With little to no development of new antibiotics in the pipeline, the agency is discussing regulations for animal feed and guidelines for human use. (Wall Street Journal)

Scientists should be able to use stem cells for biomedical research, according to a recent Harris Interactive/HealthDay poll. Almost three quarters of adults surveyed are in favor of using embryonic stem cells left over from in-vitro fertilization. These poll results remain consistent with a similar survey released in 2005. Read more »

*This blog post was originally published at ACP Internist*

Should Patient Engagement Be Regulated?

Last month in Cambridge I met Twitter friend Bryan Vartabedian, M.D. (Twitter @Doctor_V) at a meeting at Vertex Pharmaceuticals. We’ll cross paths this fall on the conference speaking circuit. [Recently] on his blog he raised a rowdy, rough, but valid point: As e-patients (obviously including me) get into the business, should they/we be regulated? He said:

  • Will industry be required to publicly list monies used for sponsorship, travel and swag support of high profile patients in the social sphere?
  • Should high visibility patients who serve as stewards and advocates disavow themselves of contact with pharma just as many academic medical centers have begun?
  • As is often the case, I don’t have an answer. I’m just raising the questions. Smart questions. My short answer:

    • Fine with me if industry discloses those payments. Nothing to hide.
    • On the other hand, I think it’s nuts and counterproductive for consumers in any industry to disconnect.

    Academic medical centers have tons of evidence of influence corrupting the academic processes that are at the core of (supposed) science. For patient advocates I don’t see that there’s currently a problem that would justify adding regulators, the ensuing budget impact, etc.

    Besides, there’s a key difference: Academics are supposed to vet industry. It’s their job in this context. Patients, on the other hand, are the consumers — the ones the industry’s supposed to serve. Read more »

    *This blog post was originally published at e-Patient Dave*

    Should Doctors Work Weekends?

    Peter Orszag wants doctors to work weekends. The former director of the White House Office of Management and Budget wrote as much in this past weekend’s New York Times:

    Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or a television network that didn’t measure its ratings. Improving the quality of health care and reducing its cost will require that doctors make many changes — but working weekends and consenting to quality management are two clear ones.

    And he’s right, to a point.

    I’ve pointed to studies showing that mortality rises on the weekends, in part due to skeleton staffs that hospitals employ on Saturday and Sunday. And, since Mr. Orszag is an economist, the cost factor is noted. Tests that get pushed off until Monday cost the health system serious dollars. The problem I have is that Mr. Orszag, like most health reformers, offers doctors little incentive in return. Read more »

    *This blog post was originally published at KevinMD.com*

    Accountable Care Organizations: Global Payments To Replace Fee For Service?

    Federal health reform and Massachusetts health reform may find a point of convergence in the development of ACOs (accountable care organizations) and the payment mechanisms that will make them tick (or hum, or do whatever it is that we want them to do).  The Federales will be holding a listening session next week on the issues raised by ACOs across the HHS and FTC landscapes.  Meanwhile, back in Boston, the inner circle of health care regulators and the regulated community are busy hashing out an approach to global payments that could be ready for prime time by January 1.

    The need for payment reform in Massachusetts has been well-documented — see the health care market report from the AG’s office, as well as an earlier report on the imperative to keep insurance risk on insurers and place performance, or quality, risk on providers.  Now, this may be easier said than done, but we’ve got some of the best and brightest working away at the issue.

    Unfortunately, the Massachusetts legislature blinked, and has not mandated the approach across the board — at least not yet.  Initially, the global, or bundled, payment for episodes of health care approach is being tentatively applied to just a couple of types of episodes of care. (See Section 64 of Chapter 288 of the Acts of 2010 – the small group market reform legislation enacted this summer.) Read more »

    *This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

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