Survey findings from the Pennsylvania Academy of Family Physicians, January 2013
Author: cmh
Report says Pennsylvania lags in public health spending – mcall.com
Pennsylvania’s public health spending ranks in the lowest tier of states, according to a new survey released Thursday.
Public health officials said the study released by Trust for America’s Health and the Robert Wood Johnson Foundation may not present a full apples-to-apples comparison with other states, but that shouldn’t detract from the main finding that the federal and state governments are failing to keep up with public health needs.
The findings in the report, "Investing in America’s Health: A State-by-State Look at Public Health Funding and Key Health Facts," showed that Pennsylvania ranks 43rd for per-capita state public health spending.
The state also gets a relatively small piece of federal public health spending, ranking 47th for state spending by the U.S. Centers for Disease Control and Prevention and 32nd for per-capita spending by the U.S. Health Resources and Services Administration.
Report says Pennsylvania lags in public health spending – mcall.com
Health Reform Hits Main Street – Kaiser Health Reform
Follow the link at the bottom for the video…
Health Reform Hits Main Street
Confused about how the new health reform law really works? This short, animated movie — featuring the "YouToons" — explains the problems with the current health care system, the changes that are happening now, and the big changes coming in 2014. Learn more about how the health reform law will affect the health insurance coverage options for individuals, families and businesses with the interactive feature "Illustrating Health Reform: How Health Insurance Coverage Will Work."
PolitiFact Virginia | Pete Snyder says Medicaid causes higher risk of surgery death
PolitiFact Virginia | Pete Snyder says Medicaid causes higher risk of surgery death
This is the fact check on that VA Medicaid outcomes study that conservatives love to willfully misinterpret:
But researchers place little of the blame on Medicaid.
They noted that Medicaid recipients are the poorest, sickest and least educated group of patients. They are the least likely group to seek preventive health care. As a result, they are more likely to enter hospitals in dire conditions that require emergency surgery.
“Medicaid patients had the highest incidence of acquired immunodeficiency syndrome, depression, liver disease, neurologic disorders and psychoses,” the study said. “Furthermore, Medicaid patients had the highest incidence of metastatic cancer.”
The researchers said that uninsured patients have similar characteristics to Medicaid recipients and that it is “plausible” that both groups may suffer from a “system bias” that limits their access to private hospitals and top physicians.
“For many surgical patients, private insurance status often allows for referral to expert surgeons for their disease,” the study said. “Alternatively, Medicaid and uninsured patients may have been referred to less skilled and less specialized surgeons.”
Does the research prove, as Snyder and other conservatives suggest, that it’s safer to be uninsured than on Medicaid? Ailawadi, co-author of the study, said it does not.
Lessons from Vermont’s Health Care Reform — NEJM
Policymakers and stakeholders in other states can learn some lessons from Vermont regarding ACA reform. First, engaging stakeholders while providing transparency at each stage of reform builds support for transition efforts. Second, the adage “work smarter, not harder” applies to the enormous task of implementing health care reforms: a central board can coordinate all implementation efforts, reduce redundancy and bureaucracy, and improve transparency. Third, the development of a health insurance exchange presents opportunities for state-specific health care innovation. And finally, instead of resisting the inevitable federal reforms in the name of federalism, states may capitalize on federal financing opportunities to build new state health programs and realize cost savings.
NEJM — Netherlands and Managed Competition
The myth that competition has been key to cost containment in the Netherlands has obscured a crucial reality. Health care systems in Europe, Canada, Japan, and beyond, all of which spend much less than the United States on medical services, rely on regulation of prices, coordinated payment, budgets, and in some cases limits on selected expensive medical technologies, to contain health care spending.5 Systemwide regulation of spending, rather than competition among insurers, is the key to controlling health care costs. The Netherlands, after all, spent much less on medical care than the United States with virtually universal insurance coverage long before it began experimenting with managed competition in 2006.
The Dutch experience provides a cautionary tale about the place of private insurance competition in health care reform. The Dutch reforms have fallen far short of expectations — a reminder that policy intentions should not be confused with outcomes and that managed competition is hardly a panacea. The idea that the Dutch reforms provide a successful model for U.S. Medicare to emulate is bizarre. The Dutch case in fact underscores the pitfalls of the casual use (and misuse) of international experience in U.S. health care reform debates.5 Before we learn from other countries’ experiences with medical care, we first need to learn about them.
Will Boomers Bankrupt Our Health Care System? Myths and Facts | Health Beat by Maggie Mahar
Will Boomers Bankrupt Our Health Care System? Myths and Facts | Health Beat by Maggie Mahar
Well worth reading, with some great Uwe Reinhardt graphics!
When the three-day conference ended yesterday, it also was apparent that developed countries share many of the same problems. One that stands out is the fact that our populations are aging. Each country faces the same question: how will a shrinking workforce possibly pay for the medicine their nations’ retirees will need?
This brings me to Princeton economist Uwe Reinhardt’s speech on the very first day of the conference. The only American to speak at WHCCE, Reinhardt focused on what he called “the folklore that people bring to the health care policy table.” By nature an iconoclast, Reinhardt spent the next 20 minutes shattering some of the myths that have become part of the received wisdom among policy-makers.
Begin with the notion that an aging population is a major factor driving health care inflation. In the U.S. this is accepted as a justification for why the nation’s health care bill now equals more than $2 trillion dollars—and why we must expect it to climb ever higher.
Bad news is often more gripping than good news, and “if you want to be a popular speaker you need to feed the paranoia of your audience,” Reinhardt observed, pointing to the first slide of his Power Point presentation—a chart illustrating just how quickly we can expect a horde of wrinkly boomers to take over the nation. Some stooped and shriveled, others proudly bloated, these former members of the Pepsi generation will be far more demanding, we’re told, than the World War II veterans who preceded them.
Report calls for doubling nation’s public health spending – The Hill’s Healthwatch
Report calls for doubling nation’s public health spending – The Hill’s Healthwatch
The United States spends more on healthcare but lags behind the rest of the industrialized world in life expectancy and childhood mortality because the government “chronically” underfunds public health systems, the Institute of Medicine argues in a new report out Tuesday.
The report calls for doubling federal spending on public health from $11.6 billion to $24 billion a year “as a starting point to meet the needs of public health departments.” The report points out that Americans spent $8,086 per person in medical care in 2009 versus $251 in public health spending.
The IOM’s Committee on Public Health Strategies to Improve Health goes on to recommend that government advisers develop a “minimum package of public health services” that every community should receive from its state and local health departments. It suggests creating a new transaction tax on medical care services to help pay for the increased spending, which over time could lower healthcare costs by reducing obesity and tobacco use.
Primary care still waiting on ACA Medicaid pay raise – amednews.com
If the states manage to screw this up, and prevent pay improvement for primary care, it could jeopardize the success of the ACA…
Washington Primary care physicians who qualify for higher Medicaid payments under the Affordable Care Act might not see these rate increases as quickly as anticipated this year.
The Medicaid program has had a long-standing reputation for paying doctors at rates far below what Medicare pays for the same services. The ACA aimed to address this problem by directing states to bump rates for primary care services provided by primary care doctors up to 100% of Medicare rates for calendar years 2013 and 2014. Because the final rule on the provision was issued in late 2012 with an effective date of Jan. 1, many family doctors were hoping to see an immediate boost in their claims payments. However, “there could be a lag of several months even from now” for the enhanced Medicaid rates to take effect, said Jeffrey Cain, MD, president of the American Academy of Family Physicians.
Some physician organizations are concerned that states are missing the opportunity to prop up primary care because they aren’t moving quickly enough to pay these higher fees.
Several administrative steps are needed first at the state and federal levels, said Neil Kirschner, senior associate of regulatory and insurer affairs for the American College of Physicians. States have until March 31 to modify their Medicaid plans accordingly and submit those changes to the federal government, which then has an additional 90 days to approve the plans. “It’s unclear how many states have done that,” he said.
In recent letters to the National Governors Assn. and the National Assn. of Medicaid Directors, the American Medical Association and other organizations representing primary care doctors called on states to enact the pay bump expeditiously and engage in active communication with physicians to notify them about the timing of the pay increase.
With the ACA provision in effect for only two years, any implementation delays will make it harder for the government to collect data to see if patient access is improving by raising Medicaid payments, Kirschner said. The longer states take, the longer physicians must wait for these enhanced payments, which could affect decisions whether to take new Medicaid patients, he said.
Primary care still waiting on ACA Medicaid pay raise – amednews.com
Special Report: Behind a cancer-treatment firm’s rosy survival claims
Wed, Mar 6 2013
By Sharon Begley and Robin Respaut
(Reuters) – When the local doctor who had been treating Vicky Hilborn told her that her rare cancer had spread throughout her body, including her brain, she and her husband refused to accept a death sentence. Within days, Keith Hilborn was on the phone with an "oncology information specialist" at Cancer Treatment Centers of America.
Hilborn had seen CTCA’s website touting survival rates better than national averages. His call secured Vicky an appointment at the for-profit, privately held company’s Philadelphia affiliate, Eastern Regional Medical Center. There, the oncologist who examined Vicky told the couple he had treated other cases of histiocytic sarcoma, the cancer of immune-system cells that she had.
"He said, ‘We’ll have you back on your feet in no time,’" Keith recalled.
Vicky’s cancer treatment was forestalled by an infection and other complications that kept her at Eastern Regional for three weeks. In July 2009, when she got back home, things changed. Despite Keith’s calls, he said, CTCA did not schedule another appointment. As his wife got sicker, Keith, a former deputy sheriff in western Pennsylvania, was reduced to begging.
The oncology information specialist "said don’t bring her here," he recalled. "I said you don’t understand; we’re going to lose her if you don’t treat her. She told me I’d just have to accept that."
Vicky Hilborn never got another appointment with CTCA. She died on September 6, 2009, at age 48.
CTCA is not unique in turning away patients. A lot of doctors, hospitals and other healthcare providers in the United States decline to treat people who can’t pay, or have inadequate insurance, among other reasons. What sets CTCA apart is that rejecting certain patients and, even more, culling some of its patients from its survival data lets the company tout in ads and post on its website patient outcomes that look dramatically better than they would if the company treated all comers. These are the rosy survival numbers that attract people like the Hilborns.
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