Health Wonk Review: Take Me To Your Leader – Egads!

Posted by: Peggy Salvatore

It is exciting to be hosting Health Wonk Review this week. For the past few weeks, I’ve been thinking about finding a unifying theme for all our bloggers’ wide-ranging topics. With health reform celebrating its six-month anniversary, what other news could top that? My first thought was to go with that, but then... you won’t believe this, I found something that was even more headline-worthy than six months of health reform. Watch this video, then let’s talk...

 

You might be thinking, what does this have to do with healthcare? So was I, except this is so bizarre, it makes a great “hook” for this week. The UN has chosen a Malaysian astrophysicist, Mazlan Othman, as this planet’s ambassador for our first alien contact. You know, just in case. Which kind of puts that whole health insurance problem in perspective, if you think about it for a minute.

So, in the spirit of “take me to your leader,” let’s start with a blog entry by one of the founders of Health Wonk Review, Joe Paduda at Managed Care Matters. In this week’s entry, Patient confidentiality? Not in Texas, Joe details some unsavory goings-on in Texas, where former state Rep. Bill Zedler, R-Arlingon, after receiving $25,000 in campaign contributions from two doctors just weeks earlier, requested and was given access to their patient records for treatments that were under investigation by the state. Those "egregious" treatment violations included injecting jet fuel into patients in order to diagnose chemical sensitivities. Former state Rep. Zedler said he had the knowledge to examine the records based on his experience as a medical device salesman. This couldn’t get any worse. Patient confidentiality is violated here on two outrageous premises: 1. A (bribed?) state legislator had access to patient records in an attempt to scuttle an investigation into alleged patient injuries and 2. A medical device salesman had access to patient records. HIPAA, schmippa.

Which leads the untrained mind to wonder. . .what kind of fuel is used in alien spacecraft? Does it get a million miles to a gallon? And can it be injected into patients?

Let’s stay with our terrestrial leaders for a minute, and visit with Health Wonk Review’s dedicated administrator Julie Ferguson at Workers’ Comp Insider. In this week’s post, Julie reviews a guide on how to select the best docs for your workers compensation programs in Required Reading: How to Find the Best Docs. She described the guide saying its “stated purpose” is to “provide specific guidance and resources to all stakeholders. . .from injured workers and employers to insurers and TPAs.”

Before we spend time in the health policy universe, let’s spin even a little farther out into the multiverse and visit Tinker Ready and the Boston Blog. This week Tinker Ready is promoting something that is oh-so-promotionally worthy in Laugh then think: Sold-out Ig Nobels to be webcast live from Harvard Thursday, 9/30. The Ig Nobels are an annual awards ceremony that takes attendees on a comic romp through the world of academia and scientific research. Also included here because Tinker Ready chose to embed video in her blog, and besides, it’s fun. Unfortunately, the event is also sold out. So you’ll have to stay home and watch the webcast.

Back on terra firma, the real controversy in health reform is playing out in the health insurance market place. David Williams at Health Business Blog posts his discussion on Narrow networks make sense, but they won’t do much to hold down premiums. In this week’s entry, David holds a comprehensive yet succinct discussion about the interplay between choice and cost, something that has been playing out since the early days of HMOs, as he points out in his blog. In the final, he concludes that this is one more trend that is going to accelerate consolidation in healthcare.

Further moving the consolidation discussion along is Austin Frakt of The Incidental Economist who sent us a post on Competition on Access. Frakt, and his associate Rex Santerre, maintain that “due to low revenue and high debt, some government health care facilities are closing while others are being sold to private-sector firms. These developments may result in normal market competition that tends to drive inefficiencies from the system. But something important could be lost when public facilities disappear – access.” This is an excellent parsing of the issue of how the delicate balance of profit, non-profit and governmental providers in a market maintain a balance of cost and quality choices, and thereby increase access due to the range of competitors. Government has acted as a healthcare safety net for generations of indigent, and Frakt and Santerre explore one aspect of what happens when the safety net has holes.

Speaking of shredding the safety net, Jason Shafrin over at the Healthcare Economist asks the question Do Medicaid Managed Care Organizations Save Money? He cites several studies showing that managed care options within the ultimate patient safety net, Medicaid, have not saved state government money and that healthcare outcomes are poorer than their commercial counterparts. For those of us who have been watching Medicaid managed care fairly closely for nearly two decades, this is not surprising.

When I first arrived on this planet in the early ‘90s (that would be the health policy planet, of course), our consulting firm was hired to do a study of then-emerging managed care entities into Medicaid in all 50 states. Our conclusions at that time have pretty much played out in these subsequent studies cited in the Healthcare Economist. Since that time, the numbers of uninsured have climbed both in terms of raw numbers and as a percentage of the population.

Rich Elmore at HealthcareTechnologyNews shares the latest discouraging census bureau statistics on the uninsured in 50.7 Million Uninsured in 2009. The charts tell the story.

And Avik Roy over at The Apothecary tells us How Medicaid is Burying the Empire State. The New York State budget crisis is exacerbated by Medicaid spending, per capita worse than any other state in the union.

The state to watch, though, is Massachusetts. David Harlow at HealthBlawg reports on the next stage of health reform in the Bay State in Massachusetts Health Care Payment Plan Gets Renewed Attention: Global Payments to Replace Fee for Service. David tells us that MassHealth (Massachusetts Medicaid) will be one of the first in the water with bundled payments for episodes of care, which is the bedrock of ACO, possibly rolling out something by January 1. All eyes will be on this. Go over and check out David’s blog to learn the details.

And no discussion of publicly funded healthcare is complete without visiting the planet Medicare which orbits in the same solar system as Medicaid. Both revolve around the sun known as the Centers for Medicare and Medicaid Services.

The Colorado Health Insurance Insider blogger says some politically motivated individuals are telling fibs about health reform. Shame on them. In Very Few Real Estate Transactions Will Be Affected by the New Medicare Tax, we hear that the 3.8% real estate tax on sales of homes and other capital gains won’t affect most people because they don’t make enough money to pay into it. Which means don’t worry, the government isn’t really going to make much money on this. And that leads us to wonder – if this law really doesn’t affect most people and won’t really generate much revenue, what’s the point?

And it just might be the ideology that gets you, according to Jaan Sidorov at The Disease Management Care Blog. In his post Ideology vs. Values in Health Reform, Jaan Sidorov takes HHS Secretary Sebelius to task for what he describes as a governing style dominated by “toxic ideology.” She and others in the Administration just don’t get the difference between ideology and values, Jaan says. And then he muses, “No wonder the Tea Partiers are being so surprisingly successful, eh?”

And speaking of ideology, remember the brouhaha over death panels? Well, so does Joanne Kenen at The New Health Dialogue. Joanne talks about the difficult job of physicians who help patients make decisions about their end-of-life care in a compassionate way, and how physicians are engaging in new ways of approaching the issue.

Still circling the governmental health reform globe, we now land at InsureBlog. This week, InsureBlog’s Bob Vineyard sends us Obamacare Roll Out – Good or Bad? In this post, Bob ponders the age-old bromide that you can’t get something for nothing, so how is it that the gang in DC has managed to convince the voters that they can? To make his point, Bob takes a look at how Obamacare would work if applied to auto insurance. He makes you laugh, and he makes you wonder if there is any intelligent life on Earth at all, or at least in the august halls of the federal government.

John Goodman’s Health Policy Blog gets down into the detail of Obamacare in Paying for Health Reform. Specifically, John revisits the content of his Wall Street Journal editorial of the previous week that criticizes the nearly systematic dismantling of one of the few success stories in government-sponsored coverage, Medicare Advantage. Visit John’s blog and get the full picture. I can’t possibly do justice in a sentence or two to this debate that engages some of the leading lights in health policy.

The threats to patients aren’t all financial. Over at Healthcare Hacks, Fred Lee discusses how Diagnostic Errors Are A Threat to Patient Safety. Fred cites a British Medical Journal article that exposes the fact that sometimes a “working diagnosis” passes for a full and correct diagnosis, which can frequently lead to the wrong treatment. Fred encourages providers to do what you might imagine they are encouraged to do at most credible medical institutions, which is to make sure that the patient receives the correct tests and that a thoughtful analysis of the clinical and laboratory evidence should be undertaken to arrive at a correct diagnosis before initiating treatment. That brings another bromide to mind: haste makes waste – and in this case, the waste is human lives.

Those old sayings have stuck around for a reason, I guess. But what about the saying that when something is really terrific that it is “out of this world?” Wonder if we’ll find out sometime soon?

Now on to my favorite healthcare topic on Earth these days, health IT. For that, let’s go to a relative newcomer to the world of blogging, Michael Koriwchak, MD over at The Wired Practice.  In this post, The ROI of EMR Explained, Michael tackles an issue we’d all love to know: will the investment in Health IT result in savings? Michael comes down on the side of the angels as he comes up with a unique approach to explaining why EMR is good for the medical practice bottom line. Like Bob Vineyard’s auto insurance analogy at InsureBlog this week, Michael also uses an analogy from the wonderful world of cars. It must have something to do with our American fascination with the automobile. Mike’s personal experience as a practicing clinician gives us great perspective on how the electronic medical record results in a more efficient practice and better patient care. He promises to continue blogging on the issue of ROI, so keep your antenna tuned for more from The Wired Practice.

And while we’re on the subject of wiring the clinical environment, Maggie Mahar weighs in at Health Beat Blog on some of the more intrusive aspects of technology in The Hospital Room of the Future, Brought to You by GE. Maggie says, “ ‘Smart Patient Rooms’ spy on nurses, doctors, and other health care workers to make sure that they are washing their hands. Over time, the technology will be expanded to check up on them in other ways.” Read about her concerns.

We have other bloggers who are less than enamored with some of the doings at large corporations. For example, Ray Poses, MD, at Health Care Renewal takes on J&J this week. In this entry, Should the President of Michigan University be Held Accountable for Johnson & Johnson’s Adulterated Drugs and Defective Devices, Health Care Renewal continues to pursue its mission as “addressing threats to health care’s core values, especially those resulting from concentration and abuse of power.” The bloggers at Health Care Renewal are also trying to come down on the side of the angels. In the true spirit of journalism, we’ll put the stories in front of you and let our readers draw their own conclusions. Read it and then, as our discriminating viewers always do, decide for yourself. Because there is, after all, some intelligent life on Earth.

And while we’re in the pharmaceutical neighborhood, let’s wander over to visit another regular to the blogosphere, Brad Wright at Wright on Health. This week, Brad looks at Free Medicine!, a take on patient assistance programs, or PAPs. In the interest of being “fair and balanced,” we present Brad’s much more favorable take on the pharmaceutical industry. He concludes that the PAPs work, and that pharmaceutical companies are doing their part to get life-saving medicines into the hands of patients who need them but can’t afford the huge price tags. Charitable works and good business frequently go hand-in-hand, and for some homosapiens it’s all about the milk of human kindness.

And finally, circling back around the health policy galaxy to my health IT home turf, for a good roundup on health IT news with a little bit of commentary thrown in, check out the HITECH Answers blog. This week the blog post on this site keeps readers informed on the House Panel Hearing on Meaningful Use. If you’ve been following the government’s push for electronic patient records, meaningful use is the 8,000 pound gorilla in the corner.

Thank you to Health Wonk Review for giving Healthcare Talent Transformation the opportunity to host this week. It’s been a lot of fun to reach out to the other bloggers and roam the healthcare universe with you. If you are of a certain vintage, you’ll understand when I say that health policy wonks don’t come from another planet, but sometimes we do colloquially “come from France.”

Comments

[hgstern]

Out. Standing! It's obvious that you've read and thought about each of these entries, and I love the way you relate them to various "alien life form" themes.

Thank you!!

[Jay Norris]

Jonena - great job! Thanks for hosting. In response to your comments about our submission:

"Which means don’t worry, the government isn’t really going to make much money on this. And that leads us to wonder – if this law really doesn’t affect most people and won’t really generate much revenue, what’s the point?"

The main point is... don't believe crazy email fwds. It is not ALL transactions as the email says.

But your interpretation: "won't really generate much revenue" and "don’t worry, the government isn’t really going to make much money on this"
does not equal "doesn't affect most people"

Check out the latest income gap figures. A relatively small number of transactions affected by this tax could still generate a substantial amount of revenue.

[permafrost]

Jonena, you and mr.paduda really need to check your facts out in the over 2 year old Texas incident re: fmr legislator Bill Zedler. The medical board here(Texas) has been immersed in to put it politely "controversy" since a former board president's husband was caught red handed concocting anonymous complaints (which by TMB administrative law are rergarded as legitimate)against all but one of her small town physician competitors(while she was serving as TMB president).You might also wish to research the local WFAA Channel 8 investigative report of approximately the same time (2008) about the fmr board administrator-now TWC/TDI consultant(70 + year old) Dr. Patrick before you draw premature conclusions. Furthermore, you may also wish to read the article in question (in full) about the fact that the information was obtained through "usual public information" channels and that other legislators are looking into the curious activities of the TMB TDI. The pretense of looking out for "patient rights" more than 2 years after the fact, while Zedler is fighting a well funded political opponent smells a bit in my book.

[permafrost]

Ms. Salvatore you may wish to review todays(10/01/2010) Fort Worth Star Telegram Op-Ed piece regarding Bill Zedler's and others years long inquiries into the dishonest practices of the Texas Medical Board and collusive punative practices of certain insurance companies re:filing of "anonymous" complaints to target certain physicians. The Austin bureaucrats may get a colonoscopy by the next legislature (hopefully).

[Peggy Salvatore]

ouch!

[steve]

"l editorial of the previous week that criticizes the nearly systematic dismantling of one of the few success stories in government-sponsored coverage, Medicare Advantage"

Success? Define success.

Steve

[Electronic Medical Record]

I was wondering the same thing. Is this video real?