Doctors and Nurses
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Your Doctor's Health Advice, Brought to You by Coke
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Understand Healthcare Reform in 2 Easy Steps
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"Doc Fix" Shows House's Health Bill Better Than Senate's
Pay for Performance: Why You Should Care (Part 2 of 3)
Published October 20, 2009 @ 06:00AM PT
Part 2: Empowered Patients
Last time we dug into what P4P actually is. Today we'll give you the P4P tools to become an empowered patient, and introduce you to their quality metrics basis. This will allow you to pay for quality versus average or sub-par care.
Ready? Quick! You’re having a heart attack. Your family called 911, and now the paramedics are asking which hospital you want to go to. How do you know? Your life may depend on it.
Pay For Performance: Why You Should Care (Part 1 of 3)
Published October 16, 2009 @ 07:00AM PT
Part 1: What Is It?
Earlier this year, amid all the yelling, name calling and finger-pointing, there was a small quiet force moving through US healthcare. It was the early adopter crowd of doctors, hospitals and health systems, girding up to become providers of coordinated, quality, and evidence-based care. I called this little-noticed movement the Silent Revolution. That loud screech I'm now hearing is the revolution reaching the mainstream.
We’ll get to the noise in Part 3 of this three-part series. First, today we’ll dig into what Pay For Performance (P4P) actually is, and in Part 2 we’ll look at how it can empower you as a patient.
Hospital Facility Fees Pick Your Pocket
Published October 14, 2009 @ 12:00PM PT
Imagine you board a flight on new carrier Post-Pay Airlines, where you pay a to-be-determined amount for your flight after you take it. Since it’s a “choose your own seating” model, you wander back and randomly select aisle seat 20C. Another passenger claims 20D across the aisle. When you arrive at your destination and deplane, a cashier hands you both a bill. Yours includes charges for the flight and the seat, $700 total, while 20D is charged $250 for the flight only. What?!
It turns out that the airline owns seat 20C, while an airplane mechanic owns 20D. Post-Pay claims it has to adhere to more stringent standards than the mechanic, though neither you nor your row-mate could tell the difference in seat quality. What’s more, the seats weren’t even labeled differently – there was no sign disclosing a surcharge. And unlike typical airline fees for baggage, food, drinks, and itinerary changes, sitting in the seat isn’t optional – it’s required to take the flight.
New Healthcare Versus Old Healthcare: Mirror Images?
Published October 12, 2009 @ 06:00AM PT
This weekend I was in the Bay Area for a trail race, but I got to experience more than the scenic views from the Oakland hills. The bonus was a personal evaluation of Berkeley’s emergency care (yes, only a healthcare consultant could possibly see it that way.) It earned a “C”, meaning it was average US healthcare: not really good, not terrible, and anxiety-producing for all the wrong reasons. So what would change under proposed healthcare reform?
First, some background. For two days before the race I had vague abdominal discomfort, but chalked it up to female cyclical issues. A few hours into the race I was no longer able to breathe, much less move, without severe, stabbing abdominal pain. I was bloated, nauseated, lightheaded, and clammy. Later I learned it was a large ovarian cyst, extremely inflamed by the constant pressure of my hydration pack belt. It left me unable to ingest anything so I became dehydrated, which made existing kidney stones symptomatic. My race was over, but the fun had just begun.
Democrats Borrow the Tea Party Approach
Published October 08, 2009 @ 10:59AM PT
Rachel Maddow just announced an amazing three-part Democratic strategy to ensure healthcare reform, and it’s an attention-getter (see the first 4:50 of the video clip.) We’re all fairly familiar with part three, using the reconciliation process to pass a bill with just 51 votes, instead of 60. But it’s the first two steps that borrow from the Tea Party approach.
It’s power broker time, ramping up techniques to dramatically increase political pressure for healthcare reform. That pressure is specifically aimed at 6 key Democratic senators who must allow a vote. What's the first step? Massive free health clinics in Arkansas, Louisiana, Nebraska, Nevada, and Montana. Hoping to shame senators Max Baucus, Mary Landrieu, Blanche Lincon, Mark Pryor, Ben Nelson, and Senate Majority Leader Harry Reid, doctors and nurses will donate their time to provide free care to thousands of the senators’ constituents who can’t afford it, making for a dramatic and heart-wrenching third-world spectacle. Houston’s recent clinic drew 1,500 people seeking treatment.
Second, if seeing thousands of their constituents in need of care doesn’t shame them, two major (and nameless) power brokers are encouraging a Senate strategy to revoke Democratic chairmanships if they block healthcare reform. Specifically, committee chairmen and sub-committee chairman who allow Republicans to force a 60-vote requirement, regardless of whether these chairmen ultimately vote in favor of the bill, will have their leadership positions revoked. Yep, that would be busting a Lieutenant Colonel down to Private in a very public demotion. It’s head-cracking time!
Last but not least, they will invoke the reconciliation rules. Just like the Republicans did to pass the $1.3 trillion and $350 billion Bush tax cuts. Apparently Republican Senator James Inhoff can’t remember that period in history, so it must have been in some other country. Maybe Canada?
Michelle Obama Enters the Health Reform Debate: The Best of the Weekend
Published September 20, 2009 @ 11:33PM PT
Every weekend, I showcase the three videos or articles that best enhanced my own understanding of the health care reform debate. After all, when you’re talking about a topic that touches each of our lives and intersects policy, politics, medicine, taxes, the legal system, our economy and budgets ranging from a blue-collar family in Pennsylvania to the federal government of the United States -- well, a fellah sometimes need a little help understanding it all!
Although I don’t normally lead off with a political story, this one is well worth it:
1.) Health Reform Watch: “Because She Said So: Michelle Obama Wants Women to Stand Up for Health Care Reform”
Fellow Change.org blogger Jen Nedau posted the First Lady’s speech on the Women’s Rights blog. During the campaign, the president had often referred to Michelle as “the closer” -- the one whose impassioned “from the heart” speeches could close the deal. The White House has determined the only way to escalate the cause of health reform over and above an address to both houses of Congress is to have the First Lady also make the issue her own. It’s not a moment too soon, writes blogger and law professor Pooja Awatramani:
One of the biggest issues Michelle Obama seemed to have with the current system was gender rating; it continues to force women to pay much higher premiums than men in private insurance plans. The actuarial argument, that women’s health care needs require regular preventive care (which in reality, women and men alike should be getting) is significantly undermined by the research which shows the ultimate cost benefits of preventive care–for both women and men. It seems both ironic and counter-productive that this justification is used to punish with higher premiums those who embark upon the proactive health maintenance which so many agree is both the key to ultimate health care cost control and one of the primary goals of health care reform. Hopefully, Obama’s optimism that such gender rating will be removed through the current reform process will prove true.
With so many challenges aligned against women, it is apparent that, as stated by the Congressional Joint Economic Committee, “The status-quo health insurance system is serving women poorly.” Perhaps this is why the Obama administration, in its drive to convince Americans that the issue of health care can no longer be pushed aside, is turning to women. A smart choice, whichever way you look at it, since women as a whole are one of the groups most strongly supporting health care reform.
Read the full analysis on the Health Reform Watch blog.
2.) Washington Post, “You Have No Idea What Health Costs”
Blogger Ezra Klein has an article in this Sunday’s paper spotlighting why it’s so hard to make those of us with employer-based benefits sit up and take notice of escalating costs. Since our employer picks up the lion’s share and the rest is usually deducted from our payroll, it’s difficult for us to realize just how unsustainably premiums are rising each year. If we did, Ezra writes, we’d be more forcefully supporting reform.
The average health-care coverage for the average family now costs $13,375, according to Kaiser. Over the past decade, premiums have increased by 138 percent. And if the trend continues, by 2019 the average family plan will cost $30,083.
Three years of slightly above-average health insurance will cost a solid six figures.
Those are numbers to marvel at. Those are numbers to fear. But they are not the numbers that loom in the minds of most Americans. And therein lies the problem for health-care reform.
Read the full article on WashingtonPost.com
3.) Movin’ Meat, “Feeling Wonkish”
When I'm not quite sure of how proposed policy changes look to someone “in the trenches” of our medical system, I often turn to this blog written by Shadowfax, an Emergency Medicine Doctor who writes eminently readable snap-analyses of health care reform. And for Shadowfax, a lazy weekend at home apparently turned into analyzing the proposed amendments for the Senate Finance Committee from the perspective of an ER doctor.
The other thing that I gained from reading this is a real appreciation of how tricky lawmaking really is. This bill, after modification to some greater or lesser degree in committee, will need to be merged with the HELP committee bill and then (one hopes) with the House bill. That's a real challenge! Sure, there will be the big partisan battles, but all the little line items are the hard parts, I think. When you come to a provision like, say the Stabenow amendments, which have no clear partisan bias and a marginal effect on cost -- and bear in mind that there may be hundreds and hundreds of these in each bill -- how do you decide which are worthy of keeping, and which get tossed? Presumably you can't keep them all, and many are probably in direct conflict. Unless the advocate for a particular bill is at the conference table, it's gotta become a little arbitrary.
The Public Option: Popular Everywhere But the U.S. Senate
Published September 14, 2009 @ 10:34PM PT
Many sound notes of exasperation that the public option continues to be the focal point of the health care fight, both on the right and the left. But at this point, their exasperation is itself becoming exasperating. At its core, we’re talking about a policy point that, despite eight months of pummeling, remains popular except in the halls of the United States Senate and the corridors of the headquarters of the insurance companies. It is the latest incarnation of the people vs. the powerful -– and I’d say folks have a right to be angry that the people seem to be losing.
Two bits of news today reinforce the unmistakable trends of continues popularity and support. Washington Post-ABC News released their latest poll, finding support for health care reform in general is split right down the middle. But giving people the choice of private insurance or the ability to voluntarily buy into a high-quality, government-administered public health insurance plan, similar to Medicare, scores better at 55%. But that’s the tip of the iceberg! When actually described correctly as being an option available only to those who don’t already have insurance, support jumps to 76%. It’s like the August of our discontent never happened.
One of the canards about the public option is that physicians won’t support it because they’ll refuse its presumably lower negotiated payment rates. But today’s New England Journal of Medicine should put the lie to that once and for all. A survey by email and phone of 2,130 physicians (well above the 800-1,000 sampling of most polls) finds tremendous support among doctors for the public option -– 63% of doctors support health reform that incorporates a choice between public and private coverage, whereas only 27% prefer reform where private insurance is the only option. Even surgeons, slightly more conservative and skeptical of reform by nature, come in at 59%.
Oh, and tomorrow the AFL-CIO is set to endorse a public option formally, after their incoming president has warned darkly about primary challenges for Democrats who vote against it.
Now I should note that popularity does not always correlate to the right policy, particularly on something as complex as health care. But let’s review. All three major Democratic nominees for president endorsed a public option two years ago. This year, so did the leadership in the House and the Senate, as did all but one committee chair with jurisdiction over health care. The last committee chair released a blueprint with a public option months ago, before changing his mind. 100 members of the House are threatening to vote against a health care bill that doesn’t contain it. The Senate Majority Leader is for it, as are the number two (Durbin) and the number three (Schumer) Democrats in the Senate. A still-popular President of the United States devotes a significant portion of his health care stump speech to it. Progressives are for it. Labor is for it. Doctors are for it. The American people are for it.
What’s on the other side? Entrenched Republican resistance that has already said jettisoning the public option isn’t enough for them to vote for the bill. And an insurance industry that’s dishing to Business Week about their ability to influence centrist senators like Baucus and Conrad and Blue Dog congressman like Ross.
It’s one thing to year in and year out lost to the lobbyists and special interests whose money and influence control the levers of power. It’s quite another to have our noses rubbed in it.
(Photo credit: The White House, via Sen. Max Baucus' web site.)
