Monthly Archives: November 2011

Do Appointment Reminders Work?

If you’ve been to the doctor in the last few years, you’ve probably gotten one a phone call reminding you from your doctor’s office reminding you of your upcoming appointment. These calls usually come from 1 to 3 days prior to your scheduled appointment. Sometimes a member of the front office staff speaks to you in person. Other times you get an automated “robo-call.” And, while I’ve never experienced it, many providers are now contacting patients with reminders sent to their cellphones as text messages.

I’ve always found these reminders annoying, because I generally keep my appointments, but for the physicians, anything that helps to avoid missed appointments is a way to improve efficiency. After all, a physician’s day littered with missed appointments isn’t much different than a plane flying with empty seats. The phone call reminders are known to produce results, but if text messages are equally effective, they would be preferable, because they’re generally cheaper to send out than paying someone to make calls. But the big question is: Do these text message reminders work?

The answer, according to a meta-analysis appearing in the latest issue of Health Services Research, is a resounding yes. The study looked only at text message reminders, and synthesizing results from 18 separate studies, they found that text message reminders increased the likelihood of appointment attendance by nearly 50%. That’s a big effect. The only thing that’s concerning is who won’t be reached if providers migrate to text message reminders over telephone calls. Cellphone use is widespread, but there are pockets of people–the elderly, those in areas without cell coverage, etc.–that would stand to forget their appointments more often, because they don’t have a cellphone. Of course, if things get really bad, it will be the folks without cellphones who come out ahead.

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Posted by on November 23, 2011 in Recent Research


Supremes to Hear Case on Affordable Care Act

The legal challenges to the Affordable Care Act commenced just as soon as the bill became law in 2010. There have already been a number of lower courts that have ruled on the constitutionality of the law’s individual mandate, and I have written fairly extensively about these cases here, here, here, here, here, here, here, and here. Those links are in chronological order, and I’d suggest reading them if you need to get up to speed quickly on the issue.

More recently, the Court of Appeals for the D.C. Circuit ruled in favor of the individual mandate, and the decision is notable in that a conservative judge and Reagan appointee broke with the precedent of conservative judges ruling against the law. In fact, he was the second judge to do so. Jonathan Cohn has more of the details over at The New Republic as does Timothy Jost at the Health Affairs blog.

This decision was the prelude to the Supreme Court’s decision to hear the Affordable Care Act case early next year. In fact, they’re not only going to hear it, they’ve set aside a record amount of time for oral arguments–5 1/2 hours to be exact. The New York Times’ Adam Liptak has more.

Meanwhile, voters in Ohio passed a meaningless referendum rejecting the individual mandate. Why is it meaningless? Because if the Supreme Court finds the individual mandate unconstitutional, the Ohio amendment won’t be necessary, and if the Court upholds the mandate, federal law trumps state law, rendering the amendment useless. Which will it be? We’ll have our answer just in time for the election in 2012.


Behind the Scenes in Washington

I have a lot of family and friends who like to complain that nothing ever gets done in Washington. While it’s true that the political process often winds up in gridlock (as the Founding Fathers’ system of checks and balances intended, by the way), that doesn’t mean that nothing happens. In fact, quite a lot happens, it just happens behind the scenes. There is extensive lobbying, most of which doesn’t make it into the paper or the evening news. If you’re not looking for the information, if you’re not part of the process, you’re not likely to know just how much activity there is at any one time.

For example, the so-called “Super Committee” is due to make its recommendations to Congress by November 23rd. The group has been tasked with identifying ways to reduce the deficit by at least $1.2 billion over the next decade. Cutting the budget means some groups stand to lose, and lobbyists who often work to make things happen, turn their attention to making sure that things (i.e., budget cuts) don’t happen to the groups they represent.

Not surprisingly, the Super Committee has heard from a number of national interest group organizations, and many of them represent the health care industry and concerns about cuts to Medicaid and/or Medicare. Kaiser Health News has compiled a list of some of the more prominent organizations and their goals for the outcome of the Super Committee’s process. It’s worth reading, and you can find it here.

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Posted by on November 18, 2011 in Congress


One-Stop Shopping

Wal-Mart used to be simply Wal-Mart. Then, it grew, and grew, and grew. Now Wal-Mart often appears as “Super Wal-Mart”–and it seems that you can get pretty much everything there. They have clothes, they have home furnishings, they have automotive supplies, pet supplies, music and electronics, fabric and crafts, books, magazines, groceries, shoes, tools, prescription drugs, optometrists, banks, and fast-food restaurants. Many even sell gasoline out in the parking lot. In fact, just about the only things you can’t get at Wal-Mart are legal advice and medical care, but corporate executives at Wal-Mart are hoping to change the latter.

Wal-Mart’s plan to begin providing primary care in a big way was first reported by Kaiser Health News. The move is ironic in that it comes at the same time that Wal-Mart announced it would further scale-back already atrocious employee health insurance benefits, but it might actually work for some basic needs.

Wal-Mart’s $4 price for many generic medications has been tremendously popular, and speaking from personal experience, undercuts the need for prescription drug coverage in many cases. It’s certainly possible that Wal-Mart can provide certain primary care services at low prices that increase access to those services and potentially steer people away from higher priced settings like emergency rooms and urgent care centers. However, there are concerns about quality and whether a retail-based primary care practice will be able to effectively manage the complex needs of people with chronic conditions. In effect, as the health care system continues to eye a movement towards the patient-centered medical home model, Wal-Mart may not be the best fit. The retail giant is a jack of all trades, but a master of none, unless cutting corners to drive prices down is a trade. They’ve cornered the market on that one, but is that how you want to care for your health?

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Posted by on November 16, 2011 in Health Care Delivery


Mitt Romney For the Public Option?

When the Affordable Care Act was passed, it made it through without the so-called “public option” that progressives everywhere thought would save the U.S. health care system. Quite simply, the public option was to be a federal insurance plan that anyone could purchase, and it was considered a way to increase choice of plans for consumers while keeping insurers accountable by providing a competitive benchmark for cost and quality of coverage.

The problem was, the GOP decided that it hated the idea of competition. Not all competition, mind you, but any competition between the federal government and private industry. Never mind that this is precisely what they put in place themselves with the introduction of Medicare Advantage plans. When the other party’s in power, the playbook reads “Always say no” and thus, the rules changed. Now it appears that Mitt Romney, possible GOP nominee for the 2012 presidential election, favors competition again. In fact, it appears that he even favors the forbidden variety of government-private sector competition.

You see, last week, Romney outlined a plan to reform Medicare if he is elected. His plan gives seniors a voucher, the amount of which is based on their income, with lower income individuals receiving bigger payments, which they can then use to purchase health insurance coverage from either the government’s Medicare program or a private health insurer that offers a plan at least as good as Medicare. In theory, there would be competition, and prices would go down. That’s right, let our seniors shop for the best deal and let private insurers compete against the federal government for their business.

What’s likely to happen, though, is that private insurers either avoid the Medicare market altogether, or they cherry-pick the healthiest seniors to ensure they can turn a profit as we’ve seen happen with Medicare Advantage. In the former case, there will be no competition to drive down costs. In the latter case, the Medicare market will essentially be segregated into a healthier group with private coverage and a sicker group with traditional Medicare, which will have the effect of making insurers more money and sticking the federal government with the bill. The Romney plan attempts to get around this by requiring the private plans to accept everyone who seeks coverage, but how that plays out is debatable.

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Posted by on November 14, 2011 in Public Option


Wonk Review For Your Review

Hank Stern at InsureBlog hosts the latest edition of the Health Wonk Review. I didn’t submit anything this go around, but a lot of other fine folks did. Check out the best of their work here.

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Posted by on November 11, 2011 in Health Wonk Review


Mandate Realists

Last week, I wrote about what might happen if the Supreme Court struck down the individual mandate portion of the Affordable Care Act, leaving the rest of the law intact. It seems that others have been chiming in to, and if I interpreted the Lewin Group’s study in Health Affairs through a “glass half-full” lens, others aren’t convinced and certainly aren’t optimistic.

One of the cynics (realists?) is Mark Hall, who I know and admire. He has a well-written article critiquing the Health Affairs piece, where else but the Health Affairs blog. In his post, he does an excellent job of explaining why Lewin’s research is an outlier and why we should put more stock in the doomsday predictions of Jonathan Gruber and friends. He also puts forward a sort of Pascal’s Wager in support of the mandate: We don’t know how bad things will be without a mandate, but we do know that things won’t be bad with the mandate, so better to make the safe bet. I actually agree with all of this, with one exception: It ignores the case of the status quo, which I think is worse than all the other elements of health reform minus the individual mandate, which is itself worse than all of the elements of health reform including the individual mandate.

I’m all for the individual mandate, I’m just not ready to throw in the towel if that single piece of the law takes a hit. For more on how there’s “no ‘silver lining’ in repealing [the] insurance mandate” check out this excellent piece from Naomi Freundlich at Health Beat.

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Posted by on November 9, 2011 in Individual Mandate

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