October 4th, 2010 by DavidHarlow in Better Health Network, Health Policy, News, Opinion
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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*
August 23rd, 2010 by DrRich in Better Health Network, Health Policy, News, Opinion, Research
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DrRich has pointed out several times that it is very important to our new healthcare system, as a matter of principle, to be able to discriminate against the obese.
The obese are being carefully groomed as a prototype, as a group whose characteristics (ostensibly, their lack of self-discipline, or their sloth, or their selfishness, or whatever other characteristics we can attribute to them to explain how their unsightly enormity differentiates them from us), will justify “special treatment” in order to serve the overriding good of the whole.
The obese are a useful target for two reasons. First, their sins against humanity are painfully obvious just by looking at them, so it is impossible for them to escape public scorn by blending in to the population, unlike some less obvious sinners such as (say) closet smokers, or pedophiles. And second, since true morbid obesity almost always has a strong genetic component, successfully demonizing the obese eventually will open the door to the demonization of individuals with any one of a host of other genetically mediated medical conditions. Read more »
*This blog post was originally published at The Covert Rationing Blog*
August 16th, 2010 by RyanDuBosar in Better Health Network, Health Policy, News, Research
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One in five Americans didn’t seek medical care for a recent illness or injury, often because of the cost, according to a survey of adults polled by a healthcare consulting firm, and the number of people who saw a doctor fell as well.
Four out of 10 adults said the cost was the main reason not to seek care, a trend that be driven by unemployment and health insurance costs, said a survey by the Deloitte Center for Health Solutions. They surveyed more than 4,000 adults. Also, 79 percent of respondents sought medical attention from a doctor or other health care professional in 2010, down from 85 percent in 2009. Read more »
*This blog post was originally published at ACP Internist*
August 11th, 2010 by admin in Better Health Network, Health Policy, Opinion
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By John Henning Schumann, M.D.
The Patient Protection and Affordable Care Act (aka “Health Care Reform”) signed by President Obama in March will revolutionize primary care in the United States. By 2014 tens of millions of uninsured people will “enter” the system by being granted insurance, either through expansion of the Medicaid program or through mandated purchasing of insurance via state pools or the private market.
This alone will have a profound impact, straining the capacity of our already frayed system. Therefore, embedded in the law are funds to encourage growth and improvement in primary care: Incentives to encourage graduates to enter primary care fields (family medicine, internal medicine, and pediatrics) and practice in underserved areas (through scholarships and loan forgiveness), and money to re-format the way that primary care is practiced and paid for. Read more »
*This blog post was originally published at ACP Internist*
August 11th, 2010 by RyanDuBosar in Better Health Network, Health Policy, News, Research
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Office-based practices are focusing increasingly on patients 45 and older, reports the Centers for Disease Control and Prevention.
In 2008, those 45 and older accounted for 57 percent of all office visits, compared to 49 percent in 1998. Prescriptions, scans and time spent with the doctor also became increasingly concentrated on those middle aged and older, according to data from the CDC’s National Center for Health Statistics.
Also, physician visits increasingly concentrated on medical and surgical specialists and less on care provided by primary care practitioners for those ages 45 and older. Furthermore, for patients ages 65 and older, the percentage of visits to primary care specialists decreased from 62 percent to 45 percent from 1978 to 2008, while the percentage of visits to physicians with a medical or surgical specialty increased from 37 percent to 55 percent. Read more »
*This blog post was originally published at ACP Internist*
