By Annmarie Timmins
The Concord Monitor
Originally published March 10, 2013
During his 1971 inaugural address, then-Gov. Walter Peterson identified seven goals for his next term. First on the Republican’s list was improving mental health care.
Peterson wanted to stop warehousing people with mental illness at the state’s psychiatric hospital and begin treating them in local communities. “A state mental institution,” Peterson told lawmakers 42 years ago, “is, more than anything else, a symbol of failure to help people in time.”
Two decades later, the state had become a national leader in mental health care by beginning what Peterson had envisioned. Lawmakers had established 10 community mental health centers and put money into local housing and local treatment. And under the leadership of then-Gov. John H. Sununu, the state had opened a modern 316-bed state hospital in place of the 19th-century-era institution, once called the New Hampshire Asylum for the Insane, that had housed nearly 2,000 people.
At the time, Donald Shumway, then director of the state’s Division of Mental Health, said the national recognition showed “our plan is really heading in the right direction.”
The acclaim would be short-lived.
Today, everyone from mental health advocates to lawmakers to Gov. Maggie Hassan describe the state’s mental health system as broken.
In a scathing 2011 critique, the federal government said mental health care here is “in crisis.” Federal officials accused the state of violating the Americans with Disabilities Act by starving the community care system in favor of unnecessary hospitalization. Last year, several patients made the same allegation in a federal lawsuit against the state that the federal government has joined.
Meanwhile, people in crisis languish in emergency rooms, sometimes for days, waiting for a hospital bed. The state’s jails and prisons have become the new mental health “‘asylum,” with an estimated 65 percent of the state prison population having a mental illness, according to a prison spokesman.
The entire article is here.
Showing posts with label Health Care Policy. Show all posts
Showing posts with label Health Care Policy. Show all posts
Friday, March 22, 2013
Thursday, March 21, 2013
Report rebuts claim that ACA is unfair to young adults
A Robert Wood Johnson Foundation/Urban Institute analysis says health system reform's coverage provisions will help mitigate the effect of setting new age rating bands.
By Jennifer Lubell
amednews.com
Originally published March 18, 2013
An Affordable Care Act provision that seeks to limit the amount by which insurance premiums can vary based on enrollees' ages won't result in young adults paying unreasonably high premiums, an analysis has concluded.
By Jennifer Lubell
amednews.com
Originally published March 18, 2013
An Affordable Care Act provision that seeks to limit the amount by which insurance premiums can vary based on enrollees' ages won't result in young adults paying unreasonably high premiums, an analysis has concluded.
The impact of the ACA's new formula for setting age rating bands has attracted recent interest in Washington. Starting in 2014 under the law, insurers will be prohibited from selling nongroup coverage to an adult 64 or older for more than three times the premium they would assign to a 21-year-old for the same coverage. This translates into a maximum 3-to-1 premium ratio based on age, which narrows the gap between what younger and older people pay for insurance now.
(cut)
A Robert Wood Johnson Foundation report prepared by the Urban Institute acknowledges that tighter ratios will lead to increased premiums for younger adults and lower premiums for older adults. However, the study projects that other ACA coverage provisions will mitigate the negative effects that young people may experience from the new age rating bands.
Saturday, March 16, 2013
How Mom’s Death Changed My Thinking About End-of-Life Care
By Charles Ornstein
ProPublica – Co-published with The
Washington Post
Originally published February 28, 2013
Here are some excerpts:
I've long observed, and sometimes
chronicled, the nasty policy battles surrounding end-of-life care. And like
many health journalists, I rolled my eyes when I heard the phrase
"death panels" used to describe a 2009 congressional
proposal that would have allowed Medicare to reimburse physicians who provided
counseling to patients about living wills and advance directives. The frenzy,
whipped up by conservative politicians and talk show hosts, forced the authors
of the Affordable Care Act to strip out that provision before the bill became
law.
Politics aside, I've always thought
that the high cost of end-of-life care is an issue worthy of discussion. About
a quarter of Medicare payments are spent in the last year of life, according to recent
estimates. And the degree of care provided to patients in that last
year — how many doctors they see, the number of intensive-care hospitalizations
— varies dramatically across states and even within states, according to the authoritative Dartmouth
Atlas.
Studies show that this care is often
futile. It doesn't always prolong lives, and it doesn't always reflect what
patients want.
In an article I wrote for the Los
Angeles Times in 2005, I quoted a doctor saying: "There's
always one more treatment, there's always one more, 'Why don't we try that?'
... But we have to realize what the goals of that patient are, which is not to
be in an intensive-care unit attached to tubes with no chance of really recovering."
Friday, March 8, 2013
Why the Ethics of Parsimonious Medicine Is Not the Ethics of Rationing
By Jon C. Tilburt and Christine Cassel
JAMA. 2013;309(8):773-774. doi:10.1001/jama.2013.368.
The ethics of rationing health care resources has been debated for decades. Opponents of rationing are concerned that societal interests will supplant respect for individual patient choice and professional judgment. Advocates argue that injustices in the current system necessitate that physicians use resources prudently on behalf of society, even in their daily work with individual patients. The debate is important, potentially divisive, and unavoidable.
Various groups have championed the cause of medicine practiced leanly, consistent with the professional responsibility to use resources wisely. These initiatives, which champion “parsimonious medicine,” have highlighted the 20% of routine practices in US medicine that add no demonstrable value to health care but that persist in the inertia and rituals of clinical work. The specialty societies and the Choosing Wisely collaborative outline commonsense principles for avoiding unnecessary, wasteful care.
Recent calls for waste avoidance and parsimonious care are not just a clever way to help physicians ration health care. Despite the intuitive similarity between themes in rationing and waste avoidance, the ethical rationales underlying the two differ considerably.
The entire article is here.
JAMA. 2013;309(8):773-774. doi:10.1001/jama.2013.368.
The ethics of rationing health care resources has been debated for decades. Opponents of rationing are concerned that societal interests will supplant respect for individual patient choice and professional judgment. Advocates argue that injustices in the current system necessitate that physicians use resources prudently on behalf of society, even in their daily work with individual patients. The debate is important, potentially divisive, and unavoidable.
Various groups have championed the cause of medicine practiced leanly, consistent with the professional responsibility to use resources wisely. These initiatives, which champion “parsimonious medicine,” have highlighted the 20% of routine practices in US medicine that add no demonstrable value to health care but that persist in the inertia and rituals of clinical work. The specialty societies and the Choosing Wisely collaborative outline commonsense principles for avoiding unnecessary, wasteful care.
Recent calls for waste avoidance and parsimonious care are not just a clever way to help physicians ration health care. Despite the intuitive similarity between themes in rationing and waste avoidance, the ethical rationales underlying the two differ considerably.
The entire article is here.
Tuesday, March 5, 2013
Bitter Pill: Why Medical Bills Are Killing Us
By Steven Brill
Time: Health & Fitness
Originally published February 20, 2013
Here are some excerpts:
I got the idea for this article when I was visiting Rice University last year. As I was leaving the campus, which is just outside the central business district of Houston, I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.
When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.
Yet those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?
What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?
The entire story is here.
Time: Health & Fitness
Originally published February 20, 2013
Here are some excerpts:
I got the idea for this article when I was visiting Rice University last year. As I was leaving the campus, which is just outside the central business district of Houston, I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.
When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.
Yet those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?
What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?
The entire story is here.
Sunday, March 3, 2013
As Families Change, Korea’s Elderly Are Turning to Suicide
By Choe Sang-Hun
The New York Times
Originally published February 16, 2013
Here is an excerpt:
The woman’s death is part of one of South Korea’s grimmest statistics: the number of people 65 and older committing suicide, which has nearly quadrupled in recent years, making the country’s rate of such deaths among the highest in the developed world. The epidemic is the counterpoint to the nation’s runaway economic success, which has worn away at the Confucian social contract that formed the bedrock of Korean culture for centuries.
That contract was built on the premise that parents would do almost anything to care for their children — in recent times, depleting their life savings to pay for a good education — and then would end their lives in their children’s care. No Social Security system was needed. Nursing homes were rare.
But as South Korea’s hard-charging younger generations joined an exodus from farms to cities in recent decades, or simply found themselves working harder in the hypercompetitive environment that helped drive the nation’s economic miracle, their parents were often left behind. Many elderly people now live out their final years poor, in rural areas with the melancholy feel of ghost towns.
The entire story is here.
The New York Times
Originally published February 16, 2013
Here is an excerpt:
The woman’s death is part of one of South Korea’s grimmest statistics: the number of people 65 and older committing suicide, which has nearly quadrupled in recent years, making the country’s rate of such deaths among the highest in the developed world. The epidemic is the counterpoint to the nation’s runaway economic success, which has worn away at the Confucian social contract that formed the bedrock of Korean culture for centuries.
That contract was built on the premise that parents would do almost anything to care for their children — in recent times, depleting their life savings to pay for a good education — and then would end their lives in their children’s care. No Social Security system was needed. Nursing homes were rare.
But as South Korea’s hard-charging younger generations joined an exodus from farms to cities in recent decades, or simply found themselves working harder in the hypercompetitive environment that helped drive the nation’s economic miracle, their parents were often left behind. Many elderly people now live out their final years poor, in rural areas with the melancholy feel of ghost towns.
The entire story is here.
Monday, February 25, 2013
U.S. proposes scrapping some obsolete Medicare regulations
By Reuters
Originally published February 13, 2013
The Obama administration on Monday proposed eliminating certain obsolete Medicare regulations, a move it said would save hospitals and other healthcare providers an estimated $676 million a year, or $3.4 billion over five years.
The Department of Health and Human Services described the targeted regulations as unnecessary or excessively burdensome and said their proposed elimination would allow greater efficiency without jeopardizing safety for the Medicare program's elderly and disabled beneficiaries.
"We are committed to cutting the red tape for healthcare facilities, including rural providers," Health and Human Services Secretary Kathleen Sebelius said in a statement.
"By eliminating outdated or overly burdensome requirements, hospitals and health care professionals can focus on treating patients," she added.
Industry representatives largely welcomed the changes, saying the proposed rule would help hospitals free up more resources for patient care.
"There are a number of particularly meaningful provisions in the proposed rule," said Chip Kahn of the Federation of American Hospitals.
The American Hospital Association, though, said it was disappointed the administration did not allow "hospitals in multi-hospital systems" to have single integrated medical staff structures.
"Hospitals are delivering more coordinated, patient-centered care and (the administration) should not let antiquated organizational structures stand in the way," AHA President Rich Umbdenstock said in a statement.
The entire article is here.
Originally published February 13, 2013
The Obama administration on Monday proposed eliminating certain obsolete Medicare regulations, a move it said would save hospitals and other healthcare providers an estimated $676 million a year, or $3.4 billion over five years.
The Department of Health and Human Services described the targeted regulations as unnecessary or excessively burdensome and said their proposed elimination would allow greater efficiency without jeopardizing safety for the Medicare program's elderly and disabled beneficiaries.
"We are committed to cutting the red tape for healthcare facilities, including rural providers," Health and Human Services Secretary Kathleen Sebelius said in a statement.
"By eliminating outdated or overly burdensome requirements, hospitals and health care professionals can focus on treating patients," she added.
Industry representatives largely welcomed the changes, saying the proposed rule would help hospitals free up more resources for patient care.
"There are a number of particularly meaningful provisions in the proposed rule," said Chip Kahn of the Federation of American Hospitals.
The American Hospital Association, though, said it was disappointed the administration did not allow "hospitals in multi-hospital systems" to have single integrated medical staff structures.
"Hospitals are delivering more coordinated, patient-centered care and (the administration) should not let antiquated organizational structures stand in the way," AHA President Rich Umbdenstock said in a statement.
The entire article is here.
Tuesday, February 19, 2013
SGR Repeal Bill Favors Primary Care
MedScape Medical News
Two members of Congress today reintroduced an ambitious bill that would repeal Medicare's sustainable growth rate (SGR) formula for setting physician pay and gradually phase out fee-for-service (FFS) reimbursement.
One major difference this time around for the bipartisan bill, originally introduced in May 2012, is that its price tag appears considerably lower, making passage more likely.
When Reps. Allyson Schwartz (D-PA) and Joe Heck, DO (R-NV), proposed this legislation last year, the Congressional Budget Office (CBO) had estimated that repealing the SGR and merely freezing current Medicare rates for 10 years would cost roughly $320 billion.
Since then, the CBO has reduced that 10-year estimate on the basis of lower than projected Medicare spending on physician services for the past 3 years. In a budget forecast released yesterday, the agency put the cost of a 10-year rate freeze at $138 billion.
The immediate effect of the bill from Schwartz and Dr. Heck, titled the Medicare Physician Payment Innovation Act, would be to avert a Medicare pay cut of roughly 25% on January 1, 2014, that is mandated by the SGR formula. Instead, the bill maintains 2013 rates through the end of 2014.
After 2014, Medicare would begin to shift from FFS to a methodology that rewards physicians for the quality and efficiency of patient care. From 2015 through 2018, the rates for primary care, preventive, and care coordination services would increase annually by 2.5% for physicians for whom 60% of Medicare allowables fall into these categories. Medicare rates for all other physician services would rise annually by 0.5%.
Meanwhile, the bill calls on the Centers for Medicare & Medicaid Services (CMS) to step up its efforts to test and evaluate new models of delivering and paying for healthcare (experiments with medical homes, accountable care organizations, and bundled payments are already underway). By October 2017, CMS must give physicians its best menu of new models to choose from. Two menu options would allow some physicians unable to fully revolutionize to participate in a modified FFS scheme.
The entire article is here.
Two members of Congress today reintroduced an ambitious bill that would repeal Medicare's sustainable growth rate (SGR) formula for setting physician pay and gradually phase out fee-for-service (FFS) reimbursement.
One major difference this time around for the bipartisan bill, originally introduced in May 2012, is that its price tag appears considerably lower, making passage more likely.
When Reps. Allyson Schwartz (D-PA) and Joe Heck, DO (R-NV), proposed this legislation last year, the Congressional Budget Office (CBO) had estimated that repealing the SGR and merely freezing current Medicare rates for 10 years would cost roughly $320 billion.
Since then, the CBO has reduced that 10-year estimate on the basis of lower than projected Medicare spending on physician services for the past 3 years. In a budget forecast released yesterday, the agency put the cost of a 10-year rate freeze at $138 billion.
The immediate effect of the bill from Schwartz and Dr. Heck, titled the Medicare Physician Payment Innovation Act, would be to avert a Medicare pay cut of roughly 25% on January 1, 2014, that is mandated by the SGR formula. Instead, the bill maintains 2013 rates through the end of 2014.
After 2014, Medicare would begin to shift from FFS to a methodology that rewards physicians for the quality and efficiency of patient care. From 2015 through 2018, the rates for primary care, preventive, and care coordination services would increase annually by 2.5% for physicians for whom 60% of Medicare allowables fall into these categories. Medicare rates for all other physician services would rise annually by 0.5%.
Meanwhile, the bill calls on the Centers for Medicare & Medicaid Services (CMS) to step up its efforts to test and evaluate new models of delivering and paying for healthcare (experiments with medical homes, accountable care organizations, and bundled payments are already underway). By October 2017, CMS must give physicians its best menu of new models to choose from. Two menu options would allow some physicians unable to fully revolutionize to participate in a modified FFS scheme.
The entire article is here.
Impending rules will guide equality for mental health
By Kelly Kennedy
USA Today
Originally published February 6, 2013
Regulations to be issued this month on the type of mental health coverage insurers must provide under the 2010 health care law may elevate mental illness to the status it needs, mental health experts say.
"Mental health solutions aren't likely to have an impact on this kind of violence," said Jennifer Mathis, deputy legal director of the Bazelon Center for Mental Health Law. "But we have a broken mental health system, and this is an opportunity to rectify that. You take your opportunities where they are."
Since the shooting of 26 people at Sandy Hook Elementary School in Newtown, Conn., President Obama has signed several executive actions designed to identify and help those with mental illness.
He has called for a discussion about mental health and has vowed to issue final rules this month that extend mental health parity to everyone who has health insurance under the health care law, also known as the Affordable Care Act.
Those regulations would go into effect in January, and though the specifics of those rules are unknown, advocates have clear ideas of what they'd like to see parity look like.
"In a broad-speaking way, we want to see parity be about what outcomes are, not specific tit-for-tat," said Debbie Plotnick, senior director of state policy at Mental Health America, a non-profit group that promotes mental wellness.
The entire story is here.
USA Today
Originally published February 6, 2013
Regulations to be issued this month on the type of mental health coverage insurers must provide under the 2010 health care law may elevate mental illness to the status it needs, mental health experts say.
"Mental health solutions aren't likely to have an impact on this kind of violence," said Jennifer Mathis, deputy legal director of the Bazelon Center for Mental Health Law. "But we have a broken mental health system, and this is an opportunity to rectify that. You take your opportunities where they are."
Since the shooting of 26 people at Sandy Hook Elementary School in Newtown, Conn., President Obama has signed several executive actions designed to identify and help those with mental illness.
He has called for a discussion about mental health and has vowed to issue final rules this month that extend mental health parity to everyone who has health insurance under the health care law, also known as the Affordable Care Act.
Those regulations would go into effect in January, and though the specifics of those rules are unknown, advocates have clear ideas of what they'd like to see parity look like.
"In a broad-speaking way, we want to see parity be about what outcomes are, not specific tit-for-tat," said Debbie Plotnick, senior director of state policy at Mental Health America, a non-profit group that promotes mental wellness.
The entire story is here.
Tuesday, February 12, 2013
Measure would strengthen mental health-care system
By ,
The bill would put in place standards for about 2,000 “federally qualified” community behavioral health centers, requiring them to provide such services as substance abuse treatment and 24-hour crisis care.
In return, facilities meeting criteria would be able to bill Medicaid for their services — a change intended to open the door to treatment for many more people and one that is estimated to cost about $1 billion over the next decade.
“There is an important gap here,” said Sen. Debbie Stabenow (D-Mich.), one of the bill’s main sponsors. She warned that too many people receive inadequate or no treatment and are at risk of their problems becoming more dangerous.
Sen. Roy Blunt (Mo.), the lead GOP sponsor of the measure, cited his state’s work in providing community health centers but also said that the recent shootings in Newtown, Conn., spotlighted shortcomings in mental health care that demand attention.
“We have a moment that works, and we have a model that works,” he said.
Additional Republican co-sponsors include Sens. Marco Rubio (Fla.) and Susan Collins (Maine). Other Democrats backing the legislation include Sens. Jack Reed (R.I.), Patrick J. Leahy (Vt.) and Barbara Boxer (Calif.).
The entire article is here.
The bill would put in place standards for about 2,000 “federally qualified” community behavioral health centers, requiring them to provide such services as substance abuse treatment and 24-hour crisis care.
In return, facilities meeting criteria would be able to bill Medicaid for their services — a change intended to open the door to treatment for many more people and one that is estimated to cost about $1 billion over the next decade.
“There is an important gap here,” said Sen. Debbie Stabenow (D-Mich.), one of the bill’s main sponsors. She warned that too many people receive inadequate or no treatment and are at risk of their problems becoming more dangerous.
Sen. Roy Blunt (Mo.), the lead GOP sponsor of the measure, cited his state’s work in providing community health centers but also said that the recent shootings in Newtown, Conn., spotlighted shortcomings in mental health care that demand attention.
“We have a moment that works, and we have a model that works,” he said.
Additional Republican co-sponsors include Sens. Marco Rubio (Fla.) and Susan Collins (Maine). Other Democrats backing the legislation include Sens. Jack Reed (R.I.), Patrick J. Leahy (Vt.) and Barbara Boxer (Calif.).
The entire article is here.
Tuesday, January 29, 2013
Warning Signs of Violent Acts Often Unclear
By BENEDICT CAREY and ANEMONA HARTOCOLLIS
The New York Times
Published: January 15, 2013
No one but a deeply disturbed individual marches into an elementary school or a movie theater and guns down random, innocent people.
That hard fact drives the public longing for a mental health system that produces clear warning signals and can somehow stop the violence. And it is now fueling a surge in legislative activity, in Washington and New York.
But these proposed changes and others like them may backfire and only reveal how broken the system is, experts said.
“Anytime you have one of these tragic cases like Newtown, it’s going to expose deficiencies in the mental health system, and provide some opportunity for reform,” said Richard J. Bonnie, a professor of public policy at the University of Virginia’s law school who led a state commission that overhauled policies after the 2007 Virginia Tech shootings that left 33 people dead. “But you have to be very careful not to overreact.”
The entire story is here.
The New York Times
Published: January 15, 2013
No one but a deeply disturbed individual marches into an elementary school or a movie theater and guns down random, innocent people.
That hard fact drives the public longing for a mental health system that produces clear warning signals and can somehow stop the violence. And it is now fueling a surge in legislative activity, in Washington and New York.
But these proposed changes and others like them may backfire and only reveal how broken the system is, experts said.
“Anytime you have one of these tragic cases like Newtown, it’s going to expose deficiencies in the mental health system, and provide some opportunity for reform,” said Richard J. Bonnie, a professor of public policy at the University of Virginia’s law school who led a state commission that overhauled policies after the 2007 Virginia Tech shootings that left 33 people dead. “But you have to be very careful not to overreact.”
The entire story is here.
Monday, January 28, 2013
In Second Look, Few Savings From Digital Health Records
By REED ABELSON and JULIE CRESWELL
The New York Times
Published: January 10, 2013
The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new analysis by the influential RAND Corporation.
Optimistic predictions by RAND in 2005 helped drive explosive growth in the electronic records industry and encouraged the federal government to give billions of dollars in financial incentives to hospitals and doctors that put the systems in place.
“We’ve not achieved the productivity and quality benefits that are unquestionably there for the taking,” said Dr. Arthur L. Kellermann, one of the authors of a reassessment by RAND that was published in this month’s edition of Health Affairs, an academic journal.
RAND’s 2005 report was paid for by a group of companies, including General Electric and Cerner Corporation, that have profited by developing and selling electronic records systems to hospitals and physician practices. Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005.
The entire story is here.
Saturday, January 26, 2013
Who Knew? Patients’ Share Of Health Spending Is Shrinking
By Jay Hancock
KHN Staff Writer
Originally published January 13, 2013
Consumer-driven medical spending may be the second-biggest story in health care, after the Affordable Care Act. As employers give workers more "skin in the game" through higher costs from purse and paycheck, the thinking goes, they'll seek more efficient treatment and hold down overall spending.
But consumers may not have as much skin in the game as experts thought, new government figures show.
Despite rapid growth in high-deductible health plans and rising employee contributions for insurance premiums, consumers' share of national health spending continued to fall in 2011, slipping to its lowest level in decades.
"I'm surprised," says Jonathan Gruber, a health economist at the Massachusetts Institute of Technology. "All the news is about the move to high-deductible health plans. Based on that logic … I would have expected it to go up."
True, medical costs are still pressuring families. Household health expense has outpaced sluggish income growth in recent years, says Micah Hartman, a statistician with the Department of Health and Human Services, which calculates the spending data.
But from a wider perspective, consumer health costs continued a trend of at least a quarter-century of taking up smaller and smaller parts of the health-spending pie. Household expense did go up. But other medical spending rose faster, especially for the government Medicare and Medicaid programs.
The entire article is here.
KHN Staff Writer
Originally published January 13, 2013
Consumer-driven medical spending may be the second-biggest story in health care, after the Affordable Care Act. As employers give workers more "skin in the game" through higher costs from purse and paycheck, the thinking goes, they'll seek more efficient treatment and hold down overall spending.
But consumers may not have as much skin in the game as experts thought, new government figures show.
Despite rapid growth in high-deductible health plans and rising employee contributions for insurance premiums, consumers' share of national health spending continued to fall in 2011, slipping to its lowest level in decades.
"I'm surprised," says Jonathan Gruber, a health economist at the Massachusetts Institute of Technology. "All the news is about the move to high-deductible health plans. Based on that logic … I would have expected it to go up."
True, medical costs are still pressuring families. Household health expense has outpaced sluggish income growth in recent years, says Micah Hartman, a statistician with the Department of Health and Human Services, which calculates the spending data.
But from a wider perspective, consumer health costs continued a trend of at least a quarter-century of taking up smaller and smaller parts of the health-spending pie. Household expense did go up. But other medical spending rose faster, especially for the government Medicare and Medicaid programs.
The entire article is here.
Monday, January 21, 2013
U.S. could save $2 trillion on health costs - study
By David Morgan
Reuters
Originally published January 10, 2012
The United States could save $2 trillion in healthcare spending over the next decade, if the U.S. government used its influence in the public and private sectors to nudge soaring costs into line with economic growth, a study released on Thursday said.
Compiled by the nonpartisan Commonwealth Fund, the study recommends holding the $2.8 trillion U.S. healthcare system to an annual spending target by having Medicare, Medicaid, other government programs and private insurers encourage providers to accelerate adoption of more cost-effective care.
Such a plan would require new legislation from a bitterly divided U.S. Congress, where Republicans would likely oppose new government controls, despite claims by the study's authors that families, employers and government budgets would receive long-sought relief from their growing financial healthcare burdens if the changes were enacted.
But Commonwealth Fund President Dr. David Blumenthal, a former healthcare adviser to President Barack Obama, said the approach could find bipartisan support in upcoming deficit talks as an alternative to cutting so-called entitlement programs including Medicare, the popular healthcare program for the elderly and disabled.
"In comparison with what some of those proposals advocate, we think that some of what we're proposing will look like an escape valve," Blumenthal told reporters in a conference call.
The United States has the world's most expensive healthcare system, which government forecasters say will cost more than $9,200 this year for every man, woman and child. Spending growth has slowed in recent years, but costs continue to outpace inflation and restrain overall economic growth.
The entire article is here.
Reuters
Originally published January 10, 2012
The United States could save $2 trillion in healthcare spending over the next decade, if the U.S. government used its influence in the public and private sectors to nudge soaring costs into line with economic growth, a study released on Thursday said.
Compiled by the nonpartisan Commonwealth Fund, the study recommends holding the $2.8 trillion U.S. healthcare system to an annual spending target by having Medicare, Medicaid, other government programs and private insurers encourage providers to accelerate adoption of more cost-effective care.
Such a plan would require new legislation from a bitterly divided U.S. Congress, where Republicans would likely oppose new government controls, despite claims by the study's authors that families, employers and government budgets would receive long-sought relief from their growing financial healthcare burdens if the changes were enacted.
But Commonwealth Fund President Dr. David Blumenthal, a former healthcare adviser to President Barack Obama, said the approach could find bipartisan support in upcoming deficit talks as an alternative to cutting so-called entitlement programs including Medicare, the popular healthcare program for the elderly and disabled.
"In comparison with what some of those proposals advocate, we think that some of what we're proposing will look like an escape valve," Blumenthal told reporters in a conference call.
The United States has the world's most expensive healthcare system, which government forecasters say will cost more than $9,200 this year for every man, woman and child. Spending growth has slowed in recent years, but costs continue to outpace inflation and restrain overall economic growth.
The entire article is here.
Wealth but not health in the USA
The Lancet
Volume 381, Issue 9862
Page 177
Last week, American people, health-care workers, and policy makers received shocking news. Despite spending more on health care per person than other high-income countries, Americans die sooner, are least likely to reach the age of 50 years, and have higher rates of disease or injury. When judged by health alone, Americans are less healthy from birth to 75 years of age than people in 16 other economically wealthy countries, and this health disadvantage has been getting worse for 30 years, especially among women.
In a report released on Jan 9 from the US National Research Council and Institute of Medicine, U.S. Health in International Perspective: Shorter Lives, Poorer Health, comprehensive mortality and morbidity data are presented, comparing the USA with affluent democratic countries including Australia, Canada, France, Italy, most of the Nordic countries, Spain, and the UK. Life expectancy is shorter at birth for American men than for men in any of the other 16 countries, and American women fare little better—Denmark is the only country that has a lower life expectancy for women at birth. In nine key areas of health, Americans fare least well, or are near the bottom of the tables. These areas are: infant mortality and low birthweight; injuries and homicides; teenage pregnancies and sexually transmitted infections; HIV/AIDS prevalence; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability. This health disadvantage applies to those with health insurance, a college education, higher incomes, and healthy behaviours as well as to those without.
Some good news in the report is that those Americans who reach 75 years live longer than their peers in other countries, and that Americans have low death rates from stroke and cancer. Moreover, current smoking rates are low, which should lead to future health benefits, and household income is relatively high.
US health spending was US$2·7 trillion in 2011, which is $8700 for every person in the country, and represents 17·9% of the economy—far greater than any other economically advanced country. But spending on health care bears little relation to good health.
Why are Americans at a health disadvantage compared with those in other countries? The fragmented US health-care system, and, in particular, poor access to health care and to primary care, are partly to blame....
The entire story is here.
Volume 381, Issue 9862
Page 177
Last week, American people, health-care workers, and policy makers received shocking news. Despite spending more on health care per person than other high-income countries, Americans die sooner, are least likely to reach the age of 50 years, and have higher rates of disease or injury. When judged by health alone, Americans are less healthy from birth to 75 years of age than people in 16 other economically wealthy countries, and this health disadvantage has been getting worse for 30 years, especially among women.
In a report released on Jan 9 from the US National Research Council and Institute of Medicine, U.S. Health in International Perspective: Shorter Lives, Poorer Health, comprehensive mortality and morbidity data are presented, comparing the USA with affluent democratic countries including Australia, Canada, France, Italy, most of the Nordic countries, Spain, and the UK. Life expectancy is shorter at birth for American men than for men in any of the other 16 countries, and American women fare little better—Denmark is the only country that has a lower life expectancy for women at birth. In nine key areas of health, Americans fare least well, or are near the bottom of the tables. These areas are: infant mortality and low birthweight; injuries and homicides; teenage pregnancies and sexually transmitted infections; HIV/AIDS prevalence; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability. This health disadvantage applies to those with health insurance, a college education, higher incomes, and healthy behaviours as well as to those without.
Some good news in the report is that those Americans who reach 75 years live longer than their peers in other countries, and that Americans have low death rates from stroke and cancer. Moreover, current smoking rates are low, which should lead to future health benefits, and household income is relatively high.
US health spending was US$2·7 trillion in 2011, which is $8700 for every person in the country, and represents 17·9% of the economy—far greater than any other economically advanced country. But spending on health care bears little relation to good health.
Why are Americans at a health disadvantage compared with those in other countries? The fragmented US health-care system, and, in particular, poor access to health care and to primary care, are partly to blame....
The entire story is here.
Wednesday, January 2, 2013
Mobile medical apps & FDA regulation
The Growth of the Health IT Sector and the Need for More Robust FDA Regulation
By Adam
Nurep
Originally posted on December 21, 2012
Over the last six years, there has been significant growth in the health technology sector (e.g. mobile medical apps), driven by advances in technology and an increase in venture capital (VC) funding. VCs have been lured into the space due to the perception of high returns on investment within shorter timeframes versus their traditional life science funds. The significant growth in this market has driven the need for increased scrutiny from the FDA in how these products should be regulated.
The FDA has the authority to regulate software if it falls within the broad definition of a “device”. It has further segmented medical devices into three classes; Class I, Class II and Class III. Class I devices don’t require FDA regulatory filing (i.e., 510(K), Premarket Approval Application (PMA)) whereas Class II requires 510(K) and Class III devices require a PMA. The class to which a device is assigned determines the type of premarketing submission/application required for FDA clearance, prior to product launch.
While the FDA has had policies in place for many years regarding the regulation of software/computer products, it has historically taken the position not to enforce the regulation unless the product interfaces directly with a medical device. In cases such as these, products have then been subjected to regulation as if they were a medical device. This caused problems for the manufacturers of these devices as there was no structured classification system based on a risk assessment, making it difficult to predict whether a device would end up being a Class I, II or III medical device. Furthermore, the rapid adoption of mobile technology within healthcare meant that there was a pressing need to develop specific guidelines around the regulation of these products also (out of the 14,558 medical apps currently available, only 75 have received clearance from the FDA).
The entire article is here.
By Adam
Nurep
Originally posted on December 21, 2012
Over the last six years, there has been significant growth in the health technology sector (e.g. mobile medical apps), driven by advances in technology and an increase in venture capital (VC) funding. VCs have been lured into the space due to the perception of high returns on investment within shorter timeframes versus their traditional life science funds. The significant growth in this market has driven the need for increased scrutiny from the FDA in how these products should be regulated.
The FDA has the authority to regulate software if it falls within the broad definition of a “device”. It has further segmented medical devices into three classes; Class I, Class II and Class III. Class I devices don’t require FDA regulatory filing (i.e., 510(K), Premarket Approval Application (PMA)) whereas Class II requires 510(K) and Class III devices require a PMA. The class to which a device is assigned determines the type of premarketing submission/application required for FDA clearance, prior to product launch.
While the FDA has had policies in place for many years regarding the regulation of software/computer products, it has historically taken the position not to enforce the regulation unless the product interfaces directly with a medical device. In cases such as these, products have then been subjected to regulation as if they were a medical device. This caused problems for the manufacturers of these devices as there was no structured classification system based on a risk assessment, making it difficult to predict whether a device would end up being a Class I, II or III medical device. Furthermore, the rapid adoption of mobile technology within healthcare meant that there was a pressing need to develop specific guidelines around the regulation of these products also (out of the 14,558 medical apps currently available, only 75 have received clearance from the FDA).
The entire article is here.
Saturday, December 29, 2012
'Not One Successful EHR System In Whole World'
Longtime advocate of computerizing healthcare C. Peter Waegemann calls current health IT policy 'misguided.'
By Neil Versel
InformationWeek
Originally posted on December 17, 2012
While federal health IT officials were touting the perceived successes of their efforts to increase physician usage of electronic health records (EHRs), one longtime advocate of EHRs was criticizing the whole direction of health IT policy.
"In my opinion, there is not one successful EHR system in the whole world," said C. Peter Waegemann, who founded and ran the Boston-based Medical Records Institute from 1984 to 2009. "User friendliness, usability, and interoperability are not there," he added in an interview with InformationWeek Healthcare.
He defined a successful EHR as one that is fully interoperable. "We have been focusing too much on documentation [for the purpose of reimbursement]," he said. This point has not been lost on the Obama administration, which has warned providers about using EHRs to "game the system."
Still, Waegemann believes the administration has not been aggressive enough with its $27 billion federal Meaningful Use EHR incentive program, based on published rules for Stage 2 and early recommendations for Stage 3. "MU2 and MU3 are just small steps. They rely on old technology," Waegemann said.
He noted that a number of leading EHR systems are written in the MUMPS programming language that originated at Massachusetts General Hospital in the late 1960s. Meaningful Use also relies on outdated standards such as version 2.x of Health Level Seven International's messaging standards rather than the more recent version 3.
The entire story is here.
By Neil Versel
InformationWeek
Originally posted on December 17, 2012
While federal health IT officials were touting the perceived successes of their efforts to increase physician usage of electronic health records (EHRs), one longtime advocate of EHRs was criticizing the whole direction of health IT policy.
"In my opinion, there is not one successful EHR system in the whole world," said C. Peter Waegemann, who founded and ran the Boston-based Medical Records Institute from 1984 to 2009. "User friendliness, usability, and interoperability are not there," he added in an interview with InformationWeek Healthcare.
He defined a successful EHR as one that is fully interoperable. "We have been focusing too much on documentation [for the purpose of reimbursement]," he said. This point has not been lost on the Obama administration, which has warned providers about using EHRs to "game the system."
Still, Waegemann believes the administration has not been aggressive enough with its $27 billion federal Meaningful Use EHR incentive program, based on published rules for Stage 2 and early recommendations for Stage 3. "MU2 and MU3 are just small steps. They rely on old technology," Waegemann said.
He noted that a number of leading EHR systems are written in the MUMPS programming language that originated at Massachusetts General Hospital in the late 1960s. Meaningful Use also relies on outdated standards such as version 2.x of Health Level Seven International's messaging standards rather than the more recent version 3.
The entire story is here.
Wednesday, December 26, 2012
New Medicare fraud detection system saves $115 million
By By KELLI KENNEDY
Associated Press
Originally published December 15, 2012
A highly touted new technology system designed to stop fraudulent Medicare payments before they are paid has saved about $115 million and spurred more than 500 investigations since it was launched in the summer of 2011, according to a report released Friday.
Federal health officials said the projected savings are much higher. The savings so far, however, are minuscule compared with the estimated $60 billion lost each year to Medicare fraud. With the Obama administration and Congress desperately looking for savings to avoid a budget meltdown, denting Medicare fraud has the potential to save billions of dollars annually.
However, the Department of Health and Human Services' inspector general noted the report had some inconsistencies in its data and questioned the methodology for calculating some of the figures.
"In these cases, we could not determine the accuracy of the department's information, which impeded our ability to quantify the amount of the inaccuracies noted in this report," the inspector general's office said in a review of the report. Officials in the office said regardless of the glitches, they believe the new fraud system is a useful anti-fraud, too.
The $77 million technology system fights fraud in much the way credit card companies scan charges and can freeze accounts. It saved $32 million by kicking providers out of the program or refusing to pay suspicious claims. The report from the Centers for Medicare and Medicaid Services, obtained by The Associated Press, was unclear on how many actual providers were suspended or revoked from Medicare.
The entire story is here.
Associated Press
Originally published December 15, 2012
A highly touted new technology system designed to stop fraudulent Medicare payments before they are paid has saved about $115 million and spurred more than 500 investigations since it was launched in the summer of 2011, according to a report released Friday.
Federal health officials said the projected savings are much higher. The savings so far, however, are minuscule compared with the estimated $60 billion lost each year to Medicare fraud. With the Obama administration and Congress desperately looking for savings to avoid a budget meltdown, denting Medicare fraud has the potential to save billions of dollars annually.
However, the Department of Health and Human Services' inspector general noted the report had some inconsistencies in its data and questioned the methodology for calculating some of the figures.
"In these cases, we could not determine the accuracy of the department's information, which impeded our ability to quantify the amount of the inaccuracies noted in this report," the inspector general's office said in a review of the report. Officials in the office said regardless of the glitches, they believe the new fraud system is a useful anti-fraud, too.
The $77 million technology system fights fraud in much the way credit card companies scan charges and can freeze accounts. It saved $32 million by kicking providers out of the program or refusing to pay suspicious claims. The report from the Centers for Medicare and Medicaid Services, obtained by The Associated Press, was unclear on how many actual providers were suspended or revoked from Medicare.
The entire story is here.
'If I'd Had To Wait Until 67 For Medicare, I'd Be Dead'
By Russ Mitchell
Kaiser Health News
Originally published December 18, 2012
Sam Lewis turned 65 in the nick of time. For a year, he'd been broke. His Brentwood, Calif., general contracting business had gone bust. He couldn't make payments on his home, and lost it. He couldn't make payments on his health insurance, so he let it lapse.
The day after his birthday in October, when he qualified for Medicare, Lewis got a checkup. Days later, he went under the knife: open-heart surgery, a triple-bypass, three arteries blocked with plaque, one of them, 99 percent. "If I'd had to wait until 67 for Medicare," Lewis said, "I'd be dead."
A proposal to raise the Medicare eligibility age from 65 to 67 to ratchet down spending is one of the more explosive ideas in the fiscal talks between House Speaker John Boehner and the White House. The negotiations are aimed at a deficit deal to avert automatic tax increases and spending cuts slated to take effect Jan. 1. Liberal Democrats say they loathe the Medicare proposal, but the White House has not taken a public position on it.
President Barack Obama was open to a similar proposal last year during his failed effort to reach a "grand bargain" with Republicans. And many expect it to pop up again in next year’s discussions about curbing entitlement costs if it is not included in this year’s deal.
The entire article is here.
Wednesday, December 19, 2012
New Taxes to Take Effect to Fund Health Care Law
By ROBERT PEAR
The New York Times
Originally Published: December 8, 2012
For more than a year, politicians have been fighting over whether to raise taxes on high-income people. They rarely mention that affluent Americans will soon be hit with new taxes adopted as part of the 2010 health care law.
The new levies, which take effect in January, include an increase in the payroll tax on wages and a tax on investment income, including interest, dividends and capital gains. The Obama administration proposed rules to enforce both last week.
Affluent people are much more likely than low-income people to have health insurance, and now they will, in effect, help pay for coverage for many lower-income families. Among the most affluent fifth of households, those affected will see tax increases averaging $6,000 next year, economists estimate.
To help finance Medicare, employees and employers each now pay a hospital insurance tax equal to 1.45 percent on all wages. Starting in January, the health care law will require workers to pay an additional tax equal to 0.9 percent of any wages over $200,000 for single taxpayers and $250,000 for married couples filing jointly.
The new taxes on wages and investment income are expected to raise $318 billion over 10 years, or about half of all the new revenue collected under the health care law.
The entire article is here.
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