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Friday, April 12, 2013

Health Care Reform Articles - April 12, 2013


President scales back Obamacare promises as cost of insurance exchanges doubles

By Alex Wayne, Bloomberg News
Posted April 11, 2013, at 2:01 p.m.
WASHINGTON — The $1.3 trillion U.S. health-care system overhaul is getting more expensive and will initially accomplish less than intended.
Costs for a network of health-insurance exchanges, a core part of the Affordable Care Act, have swelled to $4.4 billion for fiscal 2012 and 2013 combined, and will reach $5.7 billion in 2014, according to the budget President Barack Obama sent Wednesday to Congress. That spending would be more than double initial projections, even though less than half the 50 states are participating.
The unanticipated spending is a consequence of an ambitious timetable dictated by Congress and a complex new way of offering people medical coverage, say analysts, lobbyists and administration officials. Combine that with a majority of Republican governors declining to cooperate with a Democratic president and U.S. regulators are left grasping to get the 2010 health law up and running by a Jan. 1, 2014, deadline.
“Once you’re behind schedule, the way you solve problems is you write checks,” said Doug Holtz-Eakin, a former Congressional Budget Office director who is now president of the American Action Forum, which has opposed the health law.
For the areas that money can’t solve, the Obama administration is opting for delay. It temporarily backed off some provisions of the law, including restrictions on coverage for executives and a promise to offer small businesses greater choices of health plans.
The basic requirements of the health law must function by Jan. 1, even if all the bells and whistles aren’t complete, said Ron Pollack, executive director of Families USA, a consumer advocacy group that backs the overhaul.
“The Affordable Care Act is not a short term, temporary fix of America’s health-care system,” he said in an interview. “It’ll have long-term benefits, and so the administration clearly is making sure the most essential elements of the new law are effectively in place on a timely basis.”
Obama administration officials say the bulk of the health law will be up and running on time.
“There’s an awful lot to implement and we want to do it efficiently,” Ellen Murray, the assistant secretary for financial resources at the Health and Human Services Department, said in an interview. “It’s a big job, and we want to do it right.”
The government has warned that the exchanges, which are supposed to open in every state on Oct. 1, may not be easy for low-income people to navigate. In many states, people found to be eligible for Medicaid, the state-run program for the poor, will have to sign up through their state government instead of through the exchange.
“It’s a lot more complicated than anybody imagined,” Joseph Antos, a health economist at the nonprofit American Enterprise Institute who advises the CBO, said by phone.
That’s because the federal government has been forced to build part or all of the exchanges in 34 states where governors or legislatures declined to do it themselves. The government expects to spend $1.5 billion this year on the federal exchange, Murray said.
In those states, connections between computer systems that run the federal exchange and state Medicaid programs are incomplete, said Caroline Pearson, a vice president at Avalere Health, a consulting firm based in Washington that is tracking exchange development.

Obamacare Already Starts Collapsing Into Medical-Industry Feeding Frenzy

By  (about the author) 

Part of the Obama Administration's promise to the American people regarding Obamacare was that the enormous waste in America's medical expenses would be reduced. The reversal of that promise has already begun, with the Administration's announcement, on April 1st, that it will increase, instead of (as had been promised) decrease, taxpayer subsidies to private health insurance companies.
Estimates of this waste already range generally around 40%. On 15 May 2007, Reuters headlined "US Health Care Expensive, Inefficient: Report," and announced: "Americans get the poorest health care and yet pay the most compared to five other rich countries," according to a study by the Commonwealth Fund. "The U.S. health care system ranks last compared with five other countries on measures of quality, access, efficiency, equity, and outcomes." In other words, the U.S. was paying gold for garbage. "Canada rates second worst. ... Germany scored highest, followed by Britain, Australia and New Zealand." Moreover: "Per capita health spending in the United States in 2004 was $6,102, twice that of [top-rated] Germany, which spent 3,005. Canada spent $3,165, New Zealand $2,083 and Australia $2,876, while Britain spent $2,546 per person." On top of that: "U.S. doctors are the least wired, with the lowest percentage using electronic medical records or receiving electronic updates on recommended treatments." The conservatives' myth that "free market" healthcare is more efficient, or is better, or is even more "wired," than socialized health insurance, benefits only the corporate providers within the system, and the stockholders of those corporations. Everyone else loses.
On 14 March 2012, the Journal of the American Medical Association, headlined "Eliminating Waste in US Health Care," and estimated that the waste amounted to somewhere between 21% and 47% of the total U.S. medical expenses, mixed public and private.
One of the most wasteful parts of the entire system now is Medicare Part D "Advantage" private supplemental insurance plans, which are heavily subsidized by U.S. taxpayers, and yet, on average, still are costlier to Medicare recipients than is the government-run Part B program. On 25 July 2008, the Los Angeles Times bannered "Medicare Part D a Boon for Drug Companies, House Report Says: Taxpayers pay up to 30% more for prescriptions under the privately administered program" than under the publicly administered one, and Nicole Gaouette reported that, "U.S. drug manufacturers are reaping a windfall from taxpayers because Medicare's privately administered prescription drug benefit program pays more than other government programs for the same medicines. ... In the two years Medicare Part D has been in effect, drug manufacturers have taken in $3.7 billion more than they would have through prices under the Medicaid program." For example, "Bristol-Myers made an additional $400 million from higher prices for a single drug, the stroke medication Plavix."
http://www.opednews.com/articles/Obamacare-Already-Starts-C-by-Eric-Zuesse-130406-33.html


Brigham and Women’s airing medical mistakes

Hospital reports errors to staff in drive for improvement

By Liz Kowalczyk

The patient, dying of metastatic cancer, had arrived at the hospital several weeks earlier in agony. But doctors at Brigham and Women’s Hospital fashioned a medication regimen that at last eased her suffering, and on the day she was transferred to a rehabilitation hospital, they recalled seeing her smile.
Hours later, the patient was back in the Brigham emergency department, and once again in excruciating pain. Delays in transferring her, a language barrier, and a communications breakdown between doctors meant she did not get her medications on time.
Hospitals typically keep missteps like this quiet. But the Brigham openly recounted this mistake, and the improvements it led to, in a monthly online newsletter for its 16,000 employees. Brigham leaders started the publication to encourage staff to talk openly about their mistakes and propose solutions, and help make sure errors are not repeated.
While many hospitals post information on their websites about patient infections and falls, they rarely provide details of medical errors or candidly discuss with their entire staff how medical mistakes harmed patients. Executives fear the public will find out, sparking lawsuits and scaring off patients.
This reluctance, patient safety advocates warn, may be hampering the push to reduce medical errors because there is not wide discussion of how mistakes happen and can be prevented.
“Open-faced transparency is really valuable to staff at an institution because it causes them to know themselves better,” said Paul O’Neill, a member of the Lucian Leape Institute at the National Patient Safety Foundation, a nonprofit research organization based in Boston. But few, if any, other hospitals are doing anything like what the Brigham does, he said: “Unfortunately, I would say it’s highly unusual.”

Bill to allow hygienists to open clinics wins bipartisan support, but dentists question the strategy

By Matthew Stone, BDN Staff
Posted April 10, 2013, at 8:31 p.m.
AUGUSTA, Maine — A coalition that has unified some Republicans and Democrats around expanding access to dental care in Maine launched an effort Wednesday to allow a new type of dental provider to operate practices in the state.
The Dental Access for Maine coalition says allowing dental hygiene therapists — who can perform some procedures normally performed by dentists, like fillings and extractions — would fill a void in Maine, especially in remote areas of the state where access to dentists is limited.
A public hearing is scheduled Thursday for the bill the coalition is supporting, LD 1230. The legislation is sponsored by House Speaker Mark Eves, D-North Berwick, and co-sponsored by more than 40 Republican, Democratic and independent legislators.
“No one should have to get their dental care in an emergency room,” Eves said at a State House news conference where Sen. David Burns of Whiting and Rep. Heather Sirocki of Scarborough, both Republicans, also spoke.
The bill would set up a license for a dental hygiene therapist that would require a therapist to graduate from a dental hygiene therapy program and complete 500 hours of clinical training supervised by a dentist. A hygiene therapist would be allowed to operate a practice in Maine as long as he or she has a supervisory agreement with a licensed dentist.
Dental hygiene therapists already practice in Alaska and Minnesota.
“I believe this is the right approach to address a dental health need throughout the state and Washington County,” Burns said at Wednesday’s news conference.
Supporters cited statistics from a report commissioned by the Legislature in 2011 and released in February that found only 13.5 percent of dentists practice in rural areas, yet two-thirds of Maine residents live in rural areas. The report also found nearly a quarter of Maine dentists plan to retire in the next five years, and 16 percent expect to reduce their hours.
In addition, the report found that an existing dental hygienist license that allows hygienists to open independent practices has started to alleviate some of the dental care access problems in rural areas.
Allowing dental hygiene therapists in Maine won’t address one of the major underlying problems that affects the oral health of Maine’s population, said Jonathan Shenkin, a pediatric dentist in Augusta and a member of the Maine Dental Association, which is opposing LD 1230.

The Reason Health Care Is So Expensive: Insurance Companies

By Jeffrey Pfeffer
Bloomberg Businessweek, April 10, 2013
As Congressional budget battles heat up—or roll along, depending on your time perspective—the cost of health care in America receives a lot of attention. Unfortunately most of the discussion is largely off the mark about where the preventable, unnecessary costs really are. Yes, there is certainly over treatment, particularly of people in their last days of life. Yes, doctors under a fee-for-service arrangement do have financial incentives to do too much, and the fear of malpractice can lead to overtesting and overtreatment. As the recent article in Time by Steven Brill illustrated, pricing of medical care is neither invariably transparent nor sensible. And it would certainly be nice if care were better coordinated across functional specialties.
But the thing that few people talk about, and that no serious policy proposal attempts to fix—the arrangement that accounts for much of the difference between health spending in the U.S. and other places—is the enormous administrative overhead costs that come from lodging health-care reimbursement in the hands of insurance companies that have no incentive to perform their role efficiently as payment intermediaries.
More than 20 years ago, two Harvard professors published an article in the prestigious New England Journal of Medicine showing that health-care administration cost somewhere between 19 percent and 24 percent of total spending on health care and that this administrative burden helped explain why health care costs so much in the U.S. compared, for instance, with Canada or the United Kingdom. An update of that analysis more than a decade later, after the diffusion of managed care and the widespread adoption of computerization, found that administration constituted some 30 percent of U.S. health-care costs and that the share of the health-care labor force comprising administrative (as opposed to care delivery) workers had grown 50 percent to constitute more than one of every four health-sector employees.
What remains missing even in the discussion of the enormous administrative burden is not just how large, both in absolute dollars and as a percentage of health costs, it is, but also how few incentives there are for insurance companies to stop wasting their and everyone else’s time. Most large employers, including mine, Stanford University, are self-insured, which means they pay for their own medical claims. These large employers invariably hire health insurance companies to “administer” their health-care dollars, doing things such as paying claims. Employers typically reimburse the insurers the amount of money they pay out to health-care providers plus a percentage of these costs. In Stanford’s case, we pay Blue Shield 3 percent of the amount, about $3 million a year. (Note that the overhead costs of Medicare are less than one-third as much at slightly less than 1 percent.)
http://www.pnhp.org/print/news/2013/april/the-reason-health-care-is-so-expensive-insurance-companies


The great health care sinkhole

By Robert S. Kiefner, M.D.
Concord Monitor (N.H.), April 3, 2013
The bizarre and tragic loss of a Florida man a few weeks ago, slipping to his death from his bedroom into a sinkhole, offers up a fitting metaphor for the great abyss between cost and value in health care and how it has the potential to swallow us up without warning.
The periphery of that huge health care sinkhole is occupied by guys in suits – insurance companies, Big Pharma, and overpaid hospital executives and their legions of lawyers and lobbyists. In Steven Brill’s recent Time magazine expose, “Bitter Pill,” he shows how the elite of a separate health care economy are all doing quite well, while middle-class folks with serious illness are going bankrupt as a consequence of being under insured or just plain priced out of the market.
Equipped with shovels on the edge of the great sinkhole, health care executives contend that they are filling up the hole. In reality they are digging it deeper to everyone’s peril.
In the world of for-profit medicine, doctors also need to be held accountable, particularly among sub-specialties, as the gap between the pay of primary-care physicians and specialists continues to grow.
The five minutes during which an orthopedic surgeon applies a cast to a broken wrist, a dermatologist freezes a couple of barnacles on someone’s face, or a radiologist interprets an MRI are still reimbursed vastly more than a family physician might charge for an hour of managing a patient with multisystem disease, sorting through the pharmacy the patient has brought into the office in a brown paper bag, and making referrals where necessary, all while being trying to enact evidence-based medicine and maintaining an awareness of cost/benefit ratios.
The much-reported deficiencies relating to the care of the mentally ill would certainly be better addressed if we applied a fraction of the reimbursement for a broken foot to the care of a broken mind.
While the Affordable Care Act attempts to improve the lot of primary-care physicians by marginally enhancing reimbursement and recognition of the effort going into a “Patient Centered Medical Home,” the attendant costs, regulations and overall bureaucracy effectively erode the gains. Indeed, the sheer number and complexity of rules and regulations generated by the Affordable Care Act and Accountable Care Organizations have made it well nigh impossible for solo physicians, lacking in resources, to venture into private practice.
http://www.pnhp.org/print/news/2013/april/the-great-health-care-sinkhole

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