Hospitals look to lower readmission rates
Days after she was discharged to her Saugus home from Beth Israel Deaconess Medical Center after being treated for pneumonia, Carol Sewell got a call. A nurse working for both the hospital and her primary care doctor began checking in on her regularly, sometimes three times a week: Did she know about her follow-up appointments? Could she get a ride to the doctor’s office? And had she filled her prescriptions?
“It kept me doing things that I should be doing that I might not have,” Sewell said. “She’d ask questions. I’d have to have the answer.”
The calls made the 69-year-old with a history of cancer and chronic obstructive pulmonary disease feel that someone was watching out for her. Beth Israel Deaconess hopes that such intensive follow-up will help patients like Sewell maintain their health and avoid being readmitted.
Beth Israel Deaconess is one of hundreds of hospitals in the country that will lose money under a new federal program meant to force improvement in the overall care of some of the sickest seniors. Created under the Affordable Care Act, the program docks Medicare payments to hospitals whose patients are most likely to be readmitted within 30 days of treatment for pneumonia, heart failure, or heart attacks. Government officials say readmissions drive up health costs and can be a sign of inadequate care.
Much-Debated Treatment for Heart Disease Shows Slight Benefit in Clinical Trial
By ANDREW POLLACK
LOS ANGELES — To the surprise of many cardiologists, a controversial alternative therapy proved beneficial to people with heart disease, reducing the rate of death and cardiovascular problems in a clinical trial, researchers said on Sunday.
The benefit of the treatment, known as chelation therapy, barely reached statistical significance, and there were questions about the reliability of the study. Even the investigators in the trial said the results were insufficient by themselves to justify recommending use of the treatment.
Still, the unexpected finding should provide some vindication to the National Institutes of Health for sponsoring the $30 million study, which was plagued by delays and problems.
“There may be a biological effect and that biological effect should be taken seriously,” and “pursued with additional research,” Dr. Gervasio A. Lamas of Mount Sinai Medical Center in Miami, the lead investigator, said at a news conference here at the annual scientific meeting of the American Heart Association.
Dr. Elliott Antman, representing the heart association, applauded the National Institutes of Health for sponsoring the study while also expressing caution. “Intriguing as these results are, they are unexpected and should not be interpreted as an indication to adopt chelation therapy into clinical practice,” said Dr. Antman, a cardiologist at Brigham and Women’s Hospital in Boston.
Chelation therapy involves the infusion of agents that remove metals from the bloodstream.
More than 100,000 Americans with heart disease undergo chelation therapy each year, at a cost of about $5,000 per course of treatment, experts here said. The hypothesis is that chelation can remove the calcium that is a contributor to arterial plaques.
But skeptics said there was not enough evidence backing chelation therapy to even begin a clinical trial. Proponents of the study said that since chelation therapy was already widely used, it should be subject to the same rigorous scientific testing used to study conventional pharmaceuticals.
Health insurers look to redirect blame over costs
By Sarah Kliff, The Washington Post
Posted Nov. 01, 2012, at 7:58 p.m.
Health-insurance lobbyists are gearing up to deliver a new message to Congress after the election: When it comes to rising health care costs, they don’t deserve the blame.
No matter who wins the election, rising health care costs will almost certainly continue to be a financial burden. That’s true for individual consumers, who keep spending more on premiums, and for the federal government.
In discussions about that topic, health insurers rarely come across in a positive light. One survey back in the late 1990s had people say whether various industries do “good jobs.” Health insurers came in third to last, with 48 percent of Americans thinking they did a good job. They were rated worse than oil companies but better than tobacco manufacturers.
During the health-care reform debate, insurers often found their premium increases playing foil to President Obama’s call to pass the Affordable Care Act.
Moving into a potential debate over deficit reduction, health insurers want to carve out a different role in Washington. Namely, they don’t want to be the bad guys anymore. To that end, they will soon start arming their lobbyists with data suggesting that other health-care sectors are the ones to blame.
“For a number of years, when people talk about health-care costs, the debate has focused exclusively on premiums,” said Karen Ignagni, president of the Association of Health Insurance Plans (AHIP). “If you’re going to have a debate and discussion about what’s driving health care costs, you have to get under the hood.”
Ignagni said she expects that in any discussion of deficit reduction, “one of the first things we’ll do is turn our heads towards rising health care costs.” It’s possible that Medicare Advantage plans, for example, might end up on the table for reduced reimbursement rates. States could take a second look at how much they pay the health insurers that administer their Medicaid programs.
Ignagni is readying for these types of fights. Her organization plans to use federal data to argue, in statehouses and in Washington, that they are not the ones to blame for the growth in health-care costs.
The goal, Ignagni said, is to dig further into what actually drives up costs. That’s a debate, Ignagni thinks, that the insurers are well positioned to have, and win — with their many charts in hand, of course.
A Single-Payer System Would Reduce U.S. Health Care Costs
By Ed Weisbart, M.D.
Virtual Mentor: the AMA Journal of Ethics, November 2012
We Have Not Yet Solved the Health Care Crisis
The Affordable Care Act (ACA) is introducing insurance reforms that will improve the lives of millions of Americans, but we need to go much further to solve the crisis in health care.
Without correcting the fundamental structural flaws in health care financing, overall health care costs will remain poorly controlled. Though our clinical outcomes are mediocre by comparison [1], the average per capita cost of health care in the United States is twice that of other modern nations [2]. Increasingly, these costs are being borne by patients and government, driving personal bankruptcies and ever more austere public policies [3, 4]. Under the ACA, 30 million people will still have no coverage [5], and countless more will have inadequate coverage [1].
For most Americans, the glory days of “Cadillac health plans” are over, if they ever existed. The declining actuarial value of plans offered by employers means that the ACA will still leave those who need health care with financial hardships and high rates of bankruptcy, in spite of the subsidies for premiums and out-of-pocket expenses. (The actuarial value of a plan is the percentage of a patient’s predictable costs within the covered list of services that would generally be paid by the insurance company.) In order to participate in one of the ACA’s new health insurance exchanges, insurance companies are required to offer at least one “silver” and one “gold” plan, with 70 percent or 80 percent actuarial value, respectively. An insurance policy with a 70 percent actuarial value would, by definition, leave patients responsible for 30 percent of the overall cost of the care on the list of covered services. Many other medically necessary services, such as home and long-term care, dental treatment, hearing aids, and basic vision care, will not be covered and are therefore not captured in out-of-pocket maximums.
Health insurance exchanges are envisioned to function like many familiar online marketplaces, such as Travelocity or Amazon. The fate of the ACA’s health insurance exchanges may not be determined entirely until after the upcoming elections. At the moment, only a handful of states have fully committed to implementing exchanges [6]. States that do not implement an exchange will have an exchange implemented for them by the federal government, assuming Congress allocates the appropriate resources. They will be available on January 1, 2014, for uninsured individuals and small groups to compare insurance plans.
Comparison shopping makes sense when buying a product like an automobile, about which individual preferences vary widely. With health insurance, however, we all need the same thing: affordable access to high-quality health care. We need to be able to select our own physicians, but the complexities of selecting an insurance company distract us from genuinely beneficial health care activities. Given the currently dominant role of insurers in our health care, the exchanges are a step forward. But what we need is a leap forward, changing the insurance companies’ role and allowing us to focus on our health, not our insurance.
http://www.pnhp.org/print/news/2012/november/a-single-payer-system-would-reduce-us-health-care-costs
Virtual Mentor: the AMA Journal of Ethics, November 2012
We Have Not Yet Solved the Health Care Crisis
The Affordable Care Act (ACA) is introducing insurance reforms that will improve the lives of millions of Americans, but we need to go much further to solve the crisis in health care.
Without correcting the fundamental structural flaws in health care financing, overall health care costs will remain poorly controlled. Though our clinical outcomes are mediocre by comparison [1], the average per capita cost of health care in the United States is twice that of other modern nations [2]. Increasingly, these costs are being borne by patients and government, driving personal bankruptcies and ever more austere public policies [3, 4]. Under the ACA, 30 million people will still have no coverage [5], and countless more will have inadequate coverage [1].
For most Americans, the glory days of “Cadillac health plans” are over, if they ever existed. The declining actuarial value of plans offered by employers means that the ACA will still leave those who need health care with financial hardships and high rates of bankruptcy, in spite of the subsidies for premiums and out-of-pocket expenses. (The actuarial value of a plan is the percentage of a patient’s predictable costs within the covered list of services that would generally be paid by the insurance company.) In order to participate in one of the ACA’s new health insurance exchanges, insurance companies are required to offer at least one “silver” and one “gold” plan, with 70 percent or 80 percent actuarial value, respectively. An insurance policy with a 70 percent actuarial value would, by definition, leave patients responsible for 30 percent of the overall cost of the care on the list of covered services. Many other medically necessary services, such as home and long-term care, dental treatment, hearing aids, and basic vision care, will not be covered and are therefore not captured in out-of-pocket maximums.
Health insurance exchanges are envisioned to function like many familiar online marketplaces, such as Travelocity or Amazon. The fate of the ACA’s health insurance exchanges may not be determined entirely until after the upcoming elections. At the moment, only a handful of states have fully committed to implementing exchanges [6]. States that do not implement an exchange will have an exchange implemented for them by the federal government, assuming Congress allocates the appropriate resources. They will be available on January 1, 2014, for uninsured individuals and small groups to compare insurance plans.
Comparison shopping makes sense when buying a product like an automobile, about which individual preferences vary widely. With health insurance, however, we all need the same thing: affordable access to high-quality health care. We need to be able to select our own physicians, but the complexities of selecting an insurance company distract us from genuinely beneficial health care activities. Given the currently dominant role of insurers in our health care, the exchanges are a step forward. But what we need is a leap forward, changing the insurance companies’ role and allowing us to focus on our health, not our insurance.
http://www.pnhp.org/print/news/2012/november/a-single-payer-system-would-reduce-us-health-care-costs
Health is not a commodity: Let us get the language right
By Josh Freeman, M.D.
Medicine and Social Justice, Nov. 2, 2012
Sometimes the starkest realities are hidden by the language that we choose to speak about them. This week I attended two important conferences, the annual American Public Health Association (APHA) meeting of about 8,000 or more public health workers from across the country, and, on the day preceding it, the annual Physicians for a National Health Program (PNHP) meeting, with about 400 doctors and medical students.
While the PNHP program was more targeted, examining the impact of lack of access to health care in the U.S. on the health of our people, it also included international participants. One, Dr. Alex Benos of Greece, talked articulately about the impact of European Union and IMF imposed “austerity” measures on the health of the Greek people -- so bad that the child poverty rate there has risen to 16 percent. The impact of the penalties for “bad” (albeit sanctioned and even encouraged by governments) behavior by bankers is being borne by the people, and especially the poorest, in Greece, in Spain, in Portugal – and in the U.S., where the child poverty rate, 23 percent, still significantly exceeds that of Greece. While they have been dramatically underplayed by the U.S. media, there have been massive, massive, and regular demonstrations against these attacks on the people, and in Greece (as elsewhere) physicians such as Dr. Benos are there on the lines with their patients, providing medical care and demanding the core basic social services that their patients need.
“Health and health care,” Dr. Benos says, “are not commodities that exist to drive the economy. They are among the social goals which we have an economy to achieve.”
http://www.pnhp.org/print/news/2012/november/health-is-not-a-commodity-let-us-get-the-language-right
Medicine and Social Justice, Nov. 2, 2012
Sometimes the starkest realities are hidden by the language that we choose to speak about them. This week I attended two important conferences, the annual American Public Health Association (APHA) meeting of about 8,000 or more public health workers from across the country, and, on the day preceding it, the annual Physicians for a National Health Program (PNHP) meeting, with about 400 doctors and medical students.
While the PNHP program was more targeted, examining the impact of lack of access to health care in the U.S. on the health of our people, it also included international participants. One, Dr. Alex Benos of Greece, talked articulately about the impact of European Union and IMF imposed “austerity” measures on the health of the Greek people -- so bad that the child poverty rate there has risen to 16 percent. The impact of the penalties for “bad” (albeit sanctioned and even encouraged by governments) behavior by bankers is being borne by the people, and especially the poorest, in Greece, in Spain, in Portugal – and in the U.S., where the child poverty rate, 23 percent, still significantly exceeds that of Greece. While they have been dramatically underplayed by the U.S. media, there have been massive, massive, and regular demonstrations against these attacks on the people, and in Greece (as elsewhere) physicians such as Dr. Benos are there on the lines with their patients, providing medical care and demanding the core basic social services that their patients need.
“Health and health care,” Dr. Benos says, “are not commodities that exist to drive the economy. They are among the social goals which we have an economy to achieve.”
http://www.pnhp.org/print/news/2012/november/health-is-not-a-commodity-let-us-get-the-language-right
It's Time for Single-Payer
By James C. Mitchiner, M.D.
ACEP News, Aug. 7, 2012
"You can always trust the Americans to do the right thing, once they’ve tried everything else."
Winston Churchill’s iconic remark, reportedly issued at the dawn of America’s entry into World War II, is equally applicable to the present American health care debate and the crisis that spawned it.
Regardless of whether you are elated or disappointed with June’s historic Supreme Court decision upholding the constitutionality of the Affordable Care Act, it is certainly no panacea for the problems facing U.S. health care. Even with the law intact, and despite its best intentions, it will still leave some 25 million uninsured, underinsure millions more, expand the corporatization of health care, and do little to control the escalating costs of care over the long term.
So it’s clear we need to do the right thing: the creation of a national, universal, publicly funded health care system, free of the corrupting power of profit-oriented health insurance, and at the same time capable of passing constitutional muster. In short, the right thing is an expanded and improved Medicare-for-All program, otherwise known as single-payer.
Don’t be so shocked. For the last 30 years, we have tried all the alternatives, and none of them have worked. We have experimented with HMOs, PPOs, high-deductible health plans, health savings accounts, pay-for-performance, capitation, and disease management. These ideas have been promoted in various iterations, often with great fanfare, by public and private payers alike, yet none of them have shown long-term success at bending the cost curve. And the promise of the latest reforms du jour, such as Accountable Care Organizations and Patient-Centered Medical Homes, is speculative at best.
American health care is unique among the world’s democracies in that it was never planned in terms of enabling legislation or explicit constitutional authority. As others have stated, our employer-based insurance system, which now covers about 160 million Americans, was an accident of history. Its lineage can be traced to FDR’s wage and price control policies during World War II, where employers were permitted to offer workers health insurance in lieu of higher wages as a job inducement.
This benefit has evolved piecemeal into the Rube Goldberg complexity that is contemporary employer-sponsored health insurance, with some 1,200 private plans each doing the same things – medical underwriting, coordination of benefits, claims adjudication and denial, marketing, public relations, lobbying, litigating, and paying shareholder dividends and inflated CEO salaries while forcing individuals to pay a higher share of premiums, increased deductibles, expanded copays, or a combination of all three.
Taken as a whole, private insurers’ activities are duplicative, inefficient, wasteful of scarce health care resources, conducive of job lock, and completely misdirected in supporting the 21st-century health care agenda that America needs and deserves.
http://www.pnhp.org/print/news/2012/november/its-time-for-single-payer
ACEP News, Aug. 7, 2012
"You can always trust the Americans to do the right thing, once they’ve tried everything else."
Winston Churchill’s iconic remark, reportedly issued at the dawn of America’s entry into World War II, is equally applicable to the present American health care debate and the crisis that spawned it.
Regardless of whether you are elated or disappointed with June’s historic Supreme Court decision upholding the constitutionality of the Affordable Care Act, it is certainly no panacea for the problems facing U.S. health care. Even with the law intact, and despite its best intentions, it will still leave some 25 million uninsured, underinsure millions more, expand the corporatization of health care, and do little to control the escalating costs of care over the long term.
So it’s clear we need to do the right thing: the creation of a national, universal, publicly funded health care system, free of the corrupting power of profit-oriented health insurance, and at the same time capable of passing constitutional muster. In short, the right thing is an expanded and improved Medicare-for-All program, otherwise known as single-payer.
Don’t be so shocked. For the last 30 years, we have tried all the alternatives, and none of them have worked. We have experimented with HMOs, PPOs, high-deductible health plans, health savings accounts, pay-for-performance, capitation, and disease management. These ideas have been promoted in various iterations, often with great fanfare, by public and private payers alike, yet none of them have shown long-term success at bending the cost curve. And the promise of the latest reforms du jour, such as Accountable Care Organizations and Patient-Centered Medical Homes, is speculative at best.
American health care is unique among the world’s democracies in that it was never planned in terms of enabling legislation or explicit constitutional authority. As others have stated, our employer-based insurance system, which now covers about 160 million Americans, was an accident of history. Its lineage can be traced to FDR’s wage and price control policies during World War II, where employers were permitted to offer workers health insurance in lieu of higher wages as a job inducement.
This benefit has evolved piecemeal into the Rube Goldberg complexity that is contemporary employer-sponsored health insurance, with some 1,200 private plans each doing the same things – medical underwriting, coordination of benefits, claims adjudication and denial, marketing, public relations, lobbying, litigating, and paying shareholder dividends and inflated CEO salaries while forcing individuals to pay a higher share of premiums, increased deductibles, expanded copays, or a combination of all three.
Taken as a whole, private insurers’ activities are duplicative, inefficient, wasteful of scarce health care resources, conducive of job lock, and completely misdirected in supporting the 21st-century health care agenda that America needs and deserves.
http://www.pnhp.org/print/news/2012/november/its-time-for-single-payer
What Canada can teach us about fixing Medicare
By Sarah Kliff
The Washington Post, Wonk Blog, Oct. 30, 2012
There are a lot of big differences between health care in the United States and Canada. But when you look at how the two countries provide care for the elderly, it’s actually pretty similar. Both countries run an insurance plan for those over 64 that covers a defined set of benefits.
Canada has managed to provide those benefits, however, for a whole lot less. In this week’s Archives of Internal Medicine, David Himmelstein and Steffie Woolhandler look at the growth of spending on the elderly in the United States and Canada. It finds that, for the over 64 population, both in government programs, Medicare spending has grown significantly faster in the United States than in Canada.
Back in 1980, Medicare spent an average of $1,215 on each beneficiary. In Canada, that number stood at $2,141. The difference largely had to do with the level of benefits: Canadian health insurance covers about 80 percent of seniors’ medical costs, whereas Medicare covers about half. (More than 40 percent of Medicare beneficiaries will spend all assets on out-of-pocket costs during the last five years of life, according to one study.)
Since then, United States per capita spending has grown three times as quickly as it has in Canada. Here’s what that looks like in graph form, using data from the Himmelstein and Woolhandler study:
http://www.pnhp.org/print/news/2012/october/what-canada-can-teach-us-about-fixing-medicare
The Washington Post, Wonk Blog, Oct. 30, 2012
There are a lot of big differences between health care in the United States and Canada. But when you look at how the two countries provide care for the elderly, it’s actually pretty similar. Both countries run an insurance plan for those over 64 that covers a defined set of benefits.
Canada has managed to provide those benefits, however, for a whole lot less. In this week’s Archives of Internal Medicine, David Himmelstein and Steffie Woolhandler look at the growth of spending on the elderly in the United States and Canada. It finds that, for the over 64 population, both in government programs, Medicare spending has grown significantly faster in the United States than in Canada.
Back in 1980, Medicare spent an average of $1,215 on each beneficiary. In Canada, that number stood at $2,141. The difference largely had to do with the level of benefits: Canadian health insurance covers about 80 percent of seniors’ medical costs, whereas Medicare covers about half. (More than 40 percent of Medicare beneficiaries will spend all assets on out-of-pocket costs during the last five years of life, according to one study.)
Since then, United States per capita spending has grown three times as quickly as it has in Canada. Here’s what that looks like in graph form, using data from the Himmelstein and Woolhandler study:
http://www.pnhp.org/print/news/2012/october/what-canada-can-teach-us-about-fixing-medicare
Buying medical care is not like buying a car
By Charles V. Allen, M.D.
The Modesto (Calif.) Bee, Oct. 23, 2012
David Brooks ("It's past time to change Medicare," Oct. 11) is right when he says Medicare costs are too high now and will get worse unless things change.
But, no, Mr. Brooks, the solution is not in competition, free enterprise and market forces.
Buying medical care is not like buying a car. If we bought cars the way we buy health care, the car salesman would tell us when we needed a car, what kind of car we need and how much it would cost. But we wouldn't care how much it costs because we aren't paying for it. The more cars the manufacturer produced and sold, the more money he would lose. And because 20 percent of the customers buy 80 percent of the cars, he would know exactly whom to not sell cars to! Confused? No wonder.
Translation: The patient/customer usually has little control when illness hits, no choice of what must be done (the doctor/hospital decides) or what the cost is, but doesn't care (insurance is paying).
Insurance companies seek to insure mostly the healthier members, knowing that 20 percent of the public will consume 80 percent of the health dollar. Avoiding that 20 percent is mandatory to remain profitable — and most non-Medicare companies are for-profit.
Medicare was designed to be available to all — healthy or sick — and so was Medicare Advantage but a funny thing happened along the way. Call it what you may — cherry-picking or skimming — but Medicare commercial insurance companies have successfully managed to insure a population healthier and less costly than average, leaving a sicker and more expensive membership for regular Medicare — and the taxpayer.
"In 2012 alone, private (Medicare) insurers are being overpaid $34.1 billion, or $2,526 per Medicare Advantage enrollee. … It's clear that having Medicare Advantage programs compete with Medicare doesn't save us money. In fact the opposite is the case," says one physician economist a report to be published in the International Journal of Health Services. So much for competition, market forces, private enterprise and Medicare vouchers.
http://www.pnhp.org/print/news/2012/october/buying-medical-care-is-not-like-buying-a-car
The Modesto (Calif.) Bee, Oct. 23, 2012
David Brooks ("It's past time to change Medicare," Oct. 11) is right when he says Medicare costs are too high now and will get worse unless things change.
But, no, Mr. Brooks, the solution is not in competition, free enterprise and market forces.
Buying medical care is not like buying a car. If we bought cars the way we buy health care, the car salesman would tell us when we needed a car, what kind of car we need and how much it would cost. But we wouldn't care how much it costs because we aren't paying for it. The more cars the manufacturer produced and sold, the more money he would lose. And because 20 percent of the customers buy 80 percent of the cars, he would know exactly whom to not sell cars to! Confused? No wonder.
Translation: The patient/customer usually has little control when illness hits, no choice of what must be done (the doctor/hospital decides) or what the cost is, but doesn't care (insurance is paying).
Insurance companies seek to insure mostly the healthier members, knowing that 20 percent of the public will consume 80 percent of the health dollar. Avoiding that 20 percent is mandatory to remain profitable — and most non-Medicare companies are for-profit.
Medicare was designed to be available to all — healthy or sick — and so was Medicare Advantage but a funny thing happened along the way. Call it what you may — cherry-picking or skimming — but Medicare commercial insurance companies have successfully managed to insure a population healthier and less costly than average, leaving a sicker and more expensive membership for regular Medicare — and the taxpayer.
"In 2012 alone, private (Medicare) insurers are being overpaid $34.1 billion, or $2,526 per Medicare Advantage enrollee. … It's clear that having Medicare Advantage programs compete with Medicare doesn't save us money. In fact the opposite is the case," says one physician economist a report to be published in the International Journal of Health Services. So much for competition, market forces, private enterprise and Medicare vouchers.
http://www.pnhp.org/print/news/2012/october/buying-medical-care-is-not-like-buying-a-car
No comments:
Post a Comment