Health Wonk Review: Year-End Holiday Edition

Update: I noticed that many of the links were initially entered incorrectly–and attempted to send you, the reader, to the posts via my webmail account. Oops! That has hopefully now been corrected. Please let me know if you encounter any additional broken links. Thanks!
 
Time flies. In between working to finish my dissertation and traveling the country for job interviews, another year has come and gone (and this edition has been posted a little late). And, if your life has been anything like mine for the last little while, you’re probably wondering where it all went. But the year’s not over yet. There’s still time for some excellent health policy blogging. With that in mind, my Christmas gift to you is the last Health Wonk Review of 2010.

Leading things off this time is Aaron Carroll writing for the Incidental Economist. In a post entitled “Cost and Access — This Time with Income!” Aaron shows just how pervasive the problems our in our health care system. It isn’t just the poor in our country who face barriers to access, it can also be a problem for the relatively wealthy. When so much need confronts limited resources, what are we to do?

Enter Managed Care Matters blogger Joe Paduda who brings us the ugly truth that “rationing exists, it will continue to exist, and we have an obligation to ration in a fair way.” His post “Health Care Rationing – Reality in Arizona” takes a look at some of the tough decisions being made in that state’s Medicaid program, and explores the lessons they hold for all of us.

Then we have Dr. Jaan Sidorov of the Disease Management Care Blog, who presents “The Definition of Disease Management.” In this posting, Dr. Sidorov provides us with his definition of “disease management.”  Yes, it is an overused term that has fallen out of policymaking favor but Jaan thinks the concept is still useful and worth a review.  While he’s at it, he pulls some quotes from the published literature that define other related terms including, among others, “patient centered care.” If you think you know what these words and phrases mean, you might want to do yourself a favor and double check.

When we start talking about things like disease management and patient centered care, it isn’t long before the focus of discussion turns to how to finance these approaches. One oft-mentioned mechanism is pay for performance. Jason Shafrin of the Healthcare Economist takes a look at an interesting study that examines whether the frequency of evaluation makes pay-for-performance incentives more or less effective. I thought of this one in a Pavlovian sense “Do the dogs salivate more when the bell is rung immediately proceeding feeding as opposed to a few hours before?” His take is worth looking at.

And for those of you who think that Medicaid and Medicare are so much more cost-effective than private insurance, Mike Feehan of the InsureBlog would like to let you know that roughly $90 billion gets shifted from the public sector onto the private sector every year. Don’t believe it? Read his post. John Goodman also writes about what he calls “A Dumb Payment System” and explains why changes need to be made to the Medicare payment system to make it more cost-effective. Similarly, Louise of the Colorado Health Insurance Insider writes:

“It’s easy for people who aren’t in the medical profession to take the position that doctors should just accept the Medicare payment cuts, as they are probably more able to withstand the financial setback than the average American senior citizen – most of whom rely heavily on the Medicare system.  But we’ve also created a system that requires a huge financial outlay in order to become a doctor in the first place, and that has to be taken into consideration when we look at physicians’ incomes.  There is no simple solution, but in order to keep the health care system sustainable, it would seem that most players in the industry may need to accept at least some sort of pay cut.  Health insurance agents will see lower incomes across the board starting next year, as the new MLR requirements result in lower commissions, and it’s likely that numerous other aspects of health insurance administration will see financial cuts in order to comply with the new law.”

Of course, the private sector hasn’t done much better. Just take a look at the nearly worthless health insurance plans offered by places like McDonalds. Anthony Wright of the Health Access WeBlog does just that in a post entitled “Even Cheap Junk is Still Junk.” As he puts it, “Maybe something isn’t always better than nothing” when it comes to health insurance. Although, at the other extreme, according to The Hospitalist Leader’s Bradley Flansbaum, we have hospitals that are operating more like hotels than health care delivery systems–and this may have important–albeit misguided–consequences for how patients perceive the quality of care they receive. After all, Roy Poses tells us in his post on the Health Care Renewal blog, that American Medical Schools are only in it for the money. So what else should we expect?

Well, medical errors for one thing. Writing for the Health Affairs blog, Michael Millenson writes “Why We Still Kill Patients: Invisibility, Inertia, and Income.” Millenson notes the lack of progress on patient safety and asks: “Why are we still killing so many patients?” His answer: the “three I’s”: invisibility, inertia and income. The Health Business Blog also looks at errors–this time focusing on stents–and attempts to put the Abbott/St. Joseph’s/Mark Midei scandal in perspective.

Looking forward, what can we expect? It’s been a busy year, passing health reform and beginning its implementation, but as Dr. Glenn Laffel writes on the Pizaazz blog, the state courts may soon put the whole process on hold. The idea that the courts pose the biggest threat to the successful implementation of reform is nothing new, but Dr. Laffel’s lighthearted take on an issue that is of serious concern to many is actually quite refreshing.

By contrast, The Covert Rationing Blog’s Dr. Rich writes about “How the Obesity Crisis is Like the Mortgage Crisis.” Progressives have been and are still  making unwise health policy choices, he contends, and they can expect the outcome to be just as disastrous as that of the Great Recession.

In the world of health IT, Peggy Salvatore of Healthcare Talent Transformation presents “Deciphering Data in Unsettling Times” and draws the following conclusions:

When you overlay the needs of the patient care industry and the needs of the information technology industry on top of a struggling economy and its struggling participants, a picture emerges. The broad outlines are that:

1. There will be jobs in healthcare and IT 
2. Some of those jobs will be in the area where those two fields overlap
3. Pay will be kept down in some fields where specialized knowledge and higher education are not required due to supply (a lot of unemployed people) and demand (people who don’t have a lot of skills and education).
4. Pay will be driven up in some fields where specialized knowledge and education are required due to supply (a finite number of people who have a lot of special skills and education) and demand (patient care experts and IT gurus).

And Richard Elmore of Healthcare Technology News describes the Direct Project to send health care messages over the internet. Communication of health information among providers and patients is most often achieved by sending paper through the mail or via fax. The Direct Project seeks to benefit patients and providers by improving the transport of health information, making it faster, more secure, and less expensive. The Direct Project will facilitate “direct” communication patterns with an eye toward approaching more advanced levels of interoperability than simple paper can provide. It seems like a promising idea.

Whatever happens, there will be much work ahead in 2011. Some, like Avik Roy, are more cynical than others, like David Harlow. Roy writes about his disappointment with deficit reduction commission and how none of its recommendations will do anything useful for health reform. Harlow, by contrast, accentuates the positive, noting that payers and providers are going to have to learn how to collaborate better if they are to be successful in a post-reform environment. Meanwhile, at Workers’ Comp Insider, Jon Coppelman talks about the trail of unpaid liabilities facing California businesses in the wake of CRM self-insurance group (SIG) insolvency, wondering if it will be a repeat of New York’s experience with the defaulting CRM, which resulted in the collapse of the SIG system in that state. In all these matters, only time will tell.

Finally, before signing off for the year, I must engage in an act of shameless self-promotion and include a post of my own. This is the essay I wrote for a contest being held by Costs of Care. It’s not a wonkish post, but a telling narrative of the lack of price transparency in our health care system. I encourage you to read it with a nice mug of warm cider or hot cocoa as winter approaches. Cheers!

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