The Moral Healthcare Blog

COST: Is This What They Went to Med School For? | New America Blogs

COST: Is This What They Went to Med School For? New America Blogs:

Excellent summary by Joanne Kenen at New America:

“Two new studies released this week online by Health Affairs examine how health care providers, particularly physician practices, interact with insurers. One study found that doctors personally spend the equivalent of three full weeks a year on billing and related insurance information. The overall cost to their practices (their time as well as other medical and clerical personnel) was about $31 billion a year (in 2006)—which as study author Larry Casalino noted, was about six times what we spent at the time on the State Children’s Health Insurance Program and nearly 7 percent of total national expenses on physician and clinical services. Primary care practices spent more time on these administrative tasks than specialists. Very little of the data—only about two hours a year for the doctor—pertained to quality data.

“The second study looked at the billing and insurance-related activities at one large multi-site, multi-specialty California group practice. The cost (in physician and clerical time) turned out to be $85,276 per physician, or 10 percent of operating revenue. (And that excluded the time the doctors spent recording procedure and diagnosis codes). And this California practice isn’t bogged down in paper; they already use electronic medical records for both clinical and billing data. (Some older studies, before medicine began its slow and not always so steady migration to Health IT, showed even more time and money spent on administration in the days of pure paper.)”

Additionally, from the second paper:

Impact of complexity. Previous reports have suggested that the complexity inherent in the current multipayer financing system is responsible for increasing the administrative burden associated with medical groups’ transaction processing.15 During our interviews, informants frequently described the contributions of complexity in the payment system to billing and insurance burden. For example, the patient population of our study site is covered by hundreds of insurance plans, each with its own rules about benefits covered and under what conditions, payment rates, and often billing procedures. This complexity adds burden to billing and insurance tasks, including procedure coding, drug formulary authorizations, discussions with patients, submission and appeal processes, and receipt of payments. The complexity also increases the chance for error and dispute, increasing the likelihood of payment follow-up and collections. Even high-deductible plans, which might appear to avoid administrative burden for initial services during the year, impose billing/insurance costs because each service, including those within the patients’ deductibles, must be evaluated and processed.

I’ve also classified this under Physician Income and Physician Autonomy, because these burdensome duties and their concomitant expenses impact both significantly. If you think your PHIs are paying you more than Medicare, you need to factor this into the equation.

Letter – Schumer Health Care Plan – NYTimes.com

Letter – Schumer Health Care Plan – NYTimes.com:

“Re “Schumer Points to a Middle Ground on Government-Run Health Insurance” (news article, May 5):
There are a number of problems with Senator Charles E. Schumer’s so-called middle ground on universal health care. While your article acknowledges some of the structural ones — like whether a federal program could ever be subject to state laws — it doesn’t acknowledge the major issue: What is best for health care consumers?
What system is going to provide the best care? How can we provide meaningful health care to the greatest number of people with the resources available? What policies can we carry out now to ensure that there will be sufficient caregivers to meet our needs in the future?
These are the questions that we should be asking. As an advocate for consumers, I am distressed to see yet another health care discussion that focuses on the impact on insurance providers’ bottom line. The fundamental purpose of the health care system is to provide health care, not to protect and perpetuate an industry.
Richard Mollot
Executive Director, Long Term
Care Community Coalition
New York, May 5, 2009″

Well said. I was listening to a Center for American Progress Podcast of a talk given to them by Max Baucus, and I kept thinking, where is the vision? It was mostly about how we were stuck with working with our current system and tweaking it into some public-private amalgam that would be “uniquely American.” This is disappointing in many ways, but I primarily am disappointed that he reflects that stubborn conservative world view that we cannot learn from other countries, that their experiences mean little or nothing to us. If you take that view, then transformational change is impossible to envision, and you are stuck with timid change.

But also troublesome is the complementary idea that America cannot do this, because we must think so timidly, in such limited ways. JFK said, “we choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.”

Where is THAT America, Senator Baucus, Senator Schumer?

Health at a glance: OECD indicators 2005 – Google Book Search

I was looking to find the prevelance of Nurse Practitioners elsewhere in the world and found the entire OECD “Health at a glance 2005”

Very interesting.

Who has the highest paid specialists? The Netherlands.

Where do PCPs and specialists get paid the same? Portugal.

Most MRIs? Japan. CTs? Japan.

And who pays the most? Oh, you know this one!

What Is ‘Socialized Medicine’?: A Taxonomy of Health Care Systems – Economix Blog – NYTimes.com

What Is ‘Socialized Medicine’?: A Taxonomy of Health Care Systems – Economix Blog – NYTimes.com:

“Socialized medicine refers to health system in which the government owns and operates both the financing of health care and its delivery. Cell A in the chart represents socialized medicine.

“Social health insurance, on the other hand, refers to systems in which individuals transfer their financial risk of medical bills to a risk pool to which, as individuals, they contribute taxes or premiums based primarily on ability to pay, rather than on how healthy or sick they are.”
………..
“Former Mayor Rudolph Giuliani of New York has exemplified the perennial confusion in this country over socialized medicine. In his ill-fated presidential bid, and subsequently as a supporter of Senator John McCain’s bid for the presidency, Mr. Giuliani routinely decried as socialized medicine (or “socialist”) any proposal presented by Democratic candidates, because typically the latter advocated tax-financed subsidies toward the purchase of health private insurance or expansions of public insurance programs. But technically none of them advocated socialized medicine.

“Perhaps Mr. Giuliani was unaware that Americans all along the ideological spectrum reserve the purest form of socialized medicine — the V.A. health system — for the nation’s veterans. I find this cognitive dissonance amusing. Indeed, if socialized medicine is so evil, why didn’t Republicans privatize the V.A. health system when they controlled both the White House and the Congress during 2001-06?

“Mr. Giuliani also seems to forget that, in 1996, he found social health insurance a perfect solution to the financial problems faced by former Mayor John V. Lindsay, who fell on financially hard times during the 1990s as a result of chronic illness. “

The chart in the piece is a little tough, the text is better, specifically the first two paragraphs above.

But to me, the key is do we want to continue to decide who can get health care and health insurance based upon their luck? And I don’t mean luck in being financially successful, I mean luck in not getting a chronic, life threatening, debilitating illness. And if we get lucky, and make it to Medicare without a big illness, do we really want to rely on that luck holding out for our children, our nieces and nephews, our grandchildren? I don’t.

Uwe Reinhardt: A Medicare-Like Plan for the Non-Elderly – Economix Blog – NYTimes.com

A Medicare-Like Plan for the Non-Elderly – Economix Blog – NYTimes.com:

“A public health plan, however, strikes fear in the hearts of many interest groups. There are several reasons for this.

“First, it is only human that the politically powerful private health-insurance industry opposes competition from such a plan. The industry argues, not without justification, that a public plan might be advantaged by dictating to providers lower prices for health care services and products, and it might benefit from hidden subsidies. That unfair advantage could squish the private plans to the wall.

“But even if those comparative advantages could be eliminated through careful design of the public plan, the industry probably fears the inherent appeal that a public plan might have among the American people.

“The providers of health care and health care products, to whom “national health care spending” represents “national health care incomes,” fear the market power that a public health plan might bring to the demand (payment) side of the health sector.

“Greater market moxie on the demand side, they fear, might significantly bend down the lush, currently projected, long-run growth path of America’s health spending, which has national health spending rise from the current 16.6 percent of gross domestic product to 20.3 percent by 2018 and to 38 percent of G.D.P. by 2050. Once again, it is only human that the supply side of the United States health system prefers a continuance of the weaker, more fragmented demand (payment) side that for four decades now has allowed health spending to grow in excess of 2 percentage points faster than the rest of the G.D.P.

“The most powerful ordnance lobbed at the public health plan by its opponents is the dreaded “R” word, that is, the prediction that it will lead to the rationing of health care in America. In the debate on health policy, getting slapped with the R-word has always has been the kiss of death for any proposal.

“Evidently, many Americans do sincerely believe that when a public health plan refuses to pay for a procedure it is “rationing,” while denial of health care to an uninsured, low-income individual who cannot afford to pay for that care is not. But as textbooks in economics explicitly teach, the role of prices in a market economy is precisely to ration scarce resources among unlimited demands.

“The American health system has rationed health care by price and ability to pay all along for a sizeable segment of the United States population. In its report “ Hidden Cost, Value Lost,” for example, a distinguished panel of experts convened by the Institute of Medicine of the National Academy of Sciences estimated that some 18,000 Americans die prematurely for want of health insurance and timely medical care. That is rationing life years.”

Public Opinion on Health Policy

Health Policy Public Opinion Data Aggregation: h/t to Blue Texan at FDL for pointing me to this, thanks to www.pollingreport.com for putting it together!

CNN/Opinion Research Corporation Poll.
Feb. 18-19, 2009. N=1,046 adults nationwide. MoE ± 3

“In general, would you favor or oppose a program that would increase the federal government’s influence over the country’s health care system in an attempt to lower costs and provide health care coverage to more Americans?”

	Favor	Oppose	Unsure
2/18-19/09	72%	27%	1%

CBS News/New York Times Poll
Jan. 11-15, 2009. N=1,112 adults nationwide. MoE ± 3

“Should the government in Washington provide national health insurance, or is this something that should be left only to private enterprise?”

	Government	Private Enterprise	Unsure
1/11-15/09	59%	32%	9%
1/79	40%	48%	12%

Quinnipiac University Poll.
Nov. 6-10, 2008. N=2,210 registered voters nationwide. MoE ± 2.1 (for all registered voters).

“Do you think it’s the government’s responsibility to make sure that everyone in the United States has adequate health care, or don’t you think so?”

	Think It Is	Don’t Think So	Unsure
11/6-10/08	60%	36%	4%
Republicans	34%	63%	3%
Democrats	84%	12%	4%
Independents	56%	39%	5%
5/8-12/08	61%	35%	4%
10/23-29/07	57%	38%	5%
2/13-19/07	64%	31%	4%

Foregoing care due to cost | New America Blogs

HEALTH CARE: If This Is An Emergency, Please Press “Can’t Afford It” New America Blogs:

From the New America Healthcare Blog …

“Imagine being sick enough or hurt enough to rush to an emergency room—and then leaving without getting the recommended tests or treatment because you can’t afford it.

“Doctors have a name for those discharges—’Against Medical Advice.’ It seems to be happening more often, both in the ER and in the rest of the hospital as health costs rise and insurance coverage falls.

“MSNBC interviewed several doctors and patients about how the economy is affecting emergency care. A patient with acute appendicitis needing emergency surgery who waited for his mother to drive him to the hospital so he wouldn’t have to pay for an ambulance. A patient with an infected kidney stone. People with chest pains who were not in the throes of a life-threatening heart attack that very minute but who couldn’t or wouldn’t follow up to find out what the pains signaled. A 31 year old knocked unconscious in a bike crash, who asked about the cost of the recommended follow up, only to be told by the ER doctor, that she was ‘a physician, not an accountant.’ Declining treatment, he still got a $600 bill.”

There’s more at New America and at MSNBC…

I would only add this, from a wise NY Times reader:

Mr. Krugman rightly notes that emergency room care cannot substitute for health insurance since the cost will be billed directly to the patient.

There is another reason emergency rooms cannot provide adequate health care. Emergency rooms are for emergencies. They can treat a patient in a diabetic coma, but they cannot provide continuing help in managing diabetes. They can treat a full-blown asthma attack, but they cannot provide the medications needed to manage asthma daily.

They can treat a woman who has gone into early labor, but they cannot provide prenatal care.Emergency rooms cannot offer any help for managing Parkinson’s, Alzheimer’s or cancer. On a more basic level, they cannot provide eyeglasses, hearing aids or dentures.

Republican claims that no American is without access to health care because “you can just go to an emergency room” are openly false as well as appallingly callous.

Health Affairs Blog Lessons Of Medicare For The New Public Health Insurance Plan

Health Affairs Blog: Lessons Of Medicare For The New Public Health Insurance Plan:

“As Congress grapples with whether a new public health insurance plan should be created as part of health care reform, they should take stock of the nation’s experience with Medicare as a public program. Medicare’s strengths and limitations offer a number of lessons for the current debate.”

A nice summary of what is right about Medicare, as well as what to avoid (i.e., Medicaid) as we develop a Public Plan. Quick summary:

1. Medicare is stable and secure. Medicaid is subject to the whims of state governments and is therefore neither.

2. Medicare is nationally uniform, Medicaid, not so much. In fact Medicaid is pretty awful for uniformity and results in rationing of health care in many parts of the country.

3. Transparent and consistent, resulting in lower administration costs, and more predictability for all. But, they argue, and I agree, that congress should not be making the detailed coverage decisions. these should be delegated to an independant board.

4. Provide innovation and leadership in payment reform.

5. Minimizes administrative costs in a variety of ways. I know I can’t watch a sporting event, television program or anything without seeing my “not-for-profit” insurance company logo all over the place.

6. Public accountability. I always am disbelieving when i hear my conservative friends talk about governement as if it is not us. I reject this, because when we participate, it does work. Of course, the last eight years showed us that the trolley can go off the rails, but we eventually correct.

Luntz to GOP: Health reform is popular – Politico.com Print View

Luntz to GOP: Health reform is popular – Politico.com Print View: “Luntz’s 10 pointers in “The Language of Healthcare 2009”:

(1) Humanize your approach. Abandon and exile ALL references to the “healthcare system.” From now on, healthcare is about people. Before you speak, think of the three components of tone that matter most: Individualize. Personalize. Humanize.”

You know, pretend to be human, to care, to have a soul, and all that liberal sissy stuff.

There’s lots more from the master of manipulative language…