2018 goal—fix health care

So that might not happen, but at the very least a continuing resolution for CHIP, children’s health insurance that covers nearly 9 million kids, is achievable.

As for the rest; it is important to have goals. I’ve got faith.

http://thehill.com/opinion/healthcare/366668-from-chip-reauthorization-to-drug-prices-heres-whats-in-store-for-2018

Fee-for-service quick and dirty

In my holiday fervor, I forgot some key points. Doing a quick lit search brought up this lovely paper from 2008 “Health care reimbursement: Clemens to Clinton” by John T. Preskitt, MD. (John you and I should just settle down and raise a family we are perfect for each other). The answer to my stutter about when fee-for-service originated? It evolved along with Medicare, and was recognizable by the late 1950s. Managed care brought it into full flower.

One more point to be made. A crucial drawback of fee-for-service: profiting from mistakes. If you are thoughtlessly administered a drug you are allergic to–and now you’re needing all the care someone in anaphylaxis gets–you and your insurance will be billed for the privilege. Mistakes happen. Medicine is human. But failure should not be rewarded with money.

Pull quote from Preskitt’s article, which I am nicknaming “Ghosts of insurance past”

Managed care was supposed to create a system that would contain costs while simultaneously increasing the quality of care. Our traditional fee-for-service medicine had led to health care inflation because it encouraged caregivers to maximize the number of procedures they perform, ignoring preventive care. Doctors and hospitals were not paid to keep patients well; they were paid to treat them when they were sick.

Why out-of-control costs matter

Complexity. From how you get insurance (THREE MORE DAYS FOR MARKETPLACE PLANS) to who the emergency department treats to the non-communicating EMRs that create a chorus of fax tones ringing out across this great nation of over-paying under-served… well it ends like this: envelopes.

Cramming up your mailbox. Every medical service, every brick and mortar facility, every radiologist in his/her darkened bedroom reading films in memory foam slippers, is going to send to a separate bill. And this is why you still have a checkbook. Because even within the same organization, let’s say a fictional system called ANOVA that I visit for one scan, get 3 bills (physicians group, facility, and radiologist), then I go again in 3 months for the exact same thing. None of my six account numbers will be the same. Cram that in your electronic bill pay.

Here, loves, are my preventative health costs since October. Cancer screenings, with no expensive imaging like CT/MRI. Just doc visits, PAP pathology, and a radiology bill for who knows what that is? $12? I’m leaving out my $400 surprise colposcopy. But, VACCINE PLUG: get your son/daughter an HPV vaccine and the his girl/she may never know the surprise cervical pinch of colposcopy. It is a terrible thing to surprise a woman with. (I was too old, to not a virgin at 26 when vaccines became available).

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Don’t feel bad for me. Maybe set me up one of those gofundmesoIcanaffordfollowupcancersurveillanceandhaveayearlypapsinceI’msexuallyactive. Not a big draw on that?

Alright then. Just pay attention as policy, which people seem to be more averse to than illness itself, is being made. Taxes (for a few) may be losing their place on that short list of inevitability, but mortality my loves, endures.

VIDEO W/ DOG on Nurse Practitioners

Here’s a fun video for a dreary Washington Friday. Let me tell you how nurse practitioners and physician assistants are making health care available and affordable and great (again?). Featuring Peanut the dog.

Paper cited: http://firestats.com/wp-content/uploads/2013/07/S2-Naylor.pdf

CVS-AETNA merger (I told you so, mom)

The things going on in corporate health care these days. Woo! It’s like my own personal Boiler Room. Our care system is at the point in its spring cleaning when all drawers have been dumped on the floor to sort out the junk for donation, the cleaning products are strewn about, and there’s a half-built really expensive organization system that refuses to fit together. Here come the tears because HOW IS IT EVER GOING TO GET BETTER!

I get the pleasure of interviewing corporate executives, medical directors, and patients all doing the work of trying to straighten this place up — it gives me a great deal of faith that it will in fact, get better. It is going to be messy.

Today’s Upshot by Austin Frakt gives a superb sum-up of the why and what for of Sunday’s $69 billion merger. Two pull quotes below. Dust off your macroeconomics text books, it’s vertical integration in the land of the free (who pay an average of $10,000 a year on health needs). Consolidate. Cut middle men. And as always, gather ye customer base while ye may.

The CVS-Aetna deal would be just another of the many recent mergers across business lines in health care. Insurers are buying or partnering with health care providers. Health systems are offering insurance. Hospitals are employing physicians. Even Amazon is jumping into the pharmacy business in some states. This may be part of the motivation for CVS to buy Aetna — defensive jockeying to maintain access to a large customer base that might otherwise begin to fill drug prescriptions online.

One source of optimism: Research shows that coordinating pharmacy and health benefits has value because it removes perverse incentives that arise when drug and nondrug benefits are split across organizations. When pharmacy benefits are managed by a company that’s not on the hook for the cost of other care, like hospitalization, it doesn’t have as strong an incentive for increasing access to drugs that reduce other types of health care use. That could end up costing more over all.

As a postscript, I know the first thing that comes to mind when seeing “billion dollar merger” is monopoly. We hate those. With intact heavy regulation, however, monopoly is not at the top of my nightmare list for the health care industry. What is? Corporation as person, with all the legal rights of, and free from the deterring power of class action legal suits. That keeps me up.

There is a movie review in this blog.

Print journalism has been so good these past months that felt like years. Remember back in 2012, that gleeful feeling you got when you read Pete Wells’ review of the Guy Fieri superfund site in Times Square? Well, I just re-read it and it is a mere amuse bouche for the righteousness served daily by journalists at the Washington Post, New York Times, and smaller dailies in Detroit, Cincinnati, so on. Oh, lord, ProPublica’s piping hot Pulitzer-prize winning online investigative journalism. Just as you might “a plate of pale, unsalted squid rings next to a dish of sweet mayonnaise with a distant rumor of spice,” choke down this justice!

All of this is to say that print journalism is being the kind of excellent that one can only imagine was motivated by a prior laziness, a willful misinterpretation of equal coverage, a cowardice so big it created a universe of language to explain a phenomenon where one word would do (lie); all contributing to the rise of the a leader that in brief, is frickin’ dangerous.

SO! What I mean to say is now is the time to hug your journalist. And, if you like me think human lives are fascinating and the people that spend theirs writing about others even more cause they are themselves fascinating in super intelligent, hard to get along with, quirky beyond all reason ways, please watch the documentary Obit.

Somewhere buried in the documentary the writers address the “isn’t it sad to write about dead people all day” question. I couldn’t agree more with the answer, which is: not at all. They get to write about a life that, likely if it makes The New York Times, is full and brilliant, meaningful, left a legacy, and often lasted a long time.

I feel the same way about taking care of people at end-of-life. Is it sad? Not usually. Not really. No.

I regret even starting with the Guy Fieri stuff. I’ve lost my appetite.

 

 

 

 

 

 

Uwe Reinhardt’s NYT obit: clear, condensed health policy sense.

This man, what a brain. And the wit of an Ann Richards. I didn’t know of him before, but after his death every policy wonk in the pantheon was claiming Reinhardt lead them to their calling. An obit worth a read.

Why gun violence research has been shut down for 20 years – The Washington Post

Lamenting the absence of studies has been a part of our post-massacre what-can-be-done for a number of years and a larger number of mass shootings. But what could research do to get us out of these dire straits?

Scientists, lab coat-ed spreadsheet fillers, create the data that uncovers the truth. I’m not sure if you’ve heard yet but truth is a powerful thing. Evidence is the pointy triangle on which change is leveraged.

Traffic deaths, often sited by gun lobby as even with gun deaths, get a healthy amount of study. The Federal Transit Administration gave out 7 million in grants to advance transportation safety.  Research is done, evidence is collected, and regulations (seat belts, which I find sexy) are put into place. The auto industry isn’t going to make those crumple zones, laminate that glass, put in that little switch that turns your passenger airbag on and off so a tiny seat occupant is not killed by its deployment, out of the goodness of its heart.

To make industry safer, we need regulations. To make regulations, we need evidence. To make evidence, we need research.

The gun industry has put an impressive chill on learning anything about the safety of firearms. The 1996 Dickey Amendment, legislating that no research may advocate gun control, has been reauthorized every year by Congress. Data quoted in the aftermath of mass shootings is culled from CDC databases that collect cause of death information. CDC numbers tell us that guns are killing people in epic numbers. But epidemiological data alone does not a policy make.

Source: Why gun violence research has been shut down for 20 years – The Washington Post