Hospital Price Variation, Front and Center on New York Times

When Steven Brill's Time Magazine cover story, "Bitter Pill" was published back in March, it bought to light both the often inexplicable charges and wide variation in hospital billing.  While this fact is no surprise to those working in the industry nor patients who have been hit with heavy hospital bills (especially the uninsured), what Brill did was pull together several examples and personal stories into one article to garner attention.  He accomplished what he set out to do, receiving responses from the American Hospital Association, several hospitals and health systems, and was even invited to be a guest on Jon Stewart's The Daily Show.

Now, CMS (Centers for Medicare and Medicaid Services) has published further proof of price variation. "Data being released for the first time by the government on Wednesday shows that hospitals charge Medicare wildly differing amounts — sometimes 10 to 20 times what Medicare typically reimburses — for the same procedure, raising questions about how hospitals determine prices and why they differ so widely," reported The New York Times today, on it's homepage.

Yet another argument in support of moving towards bundled payment.  To read more about this exciting new healthcare trend, click here.

Uwe Reinhardt vs. MD

Uwe Reinhardt's latest blog post discusses quality of care under traditional vs. Managed Medicare plans - snooze! (but kinda interesting - conclusion was slightly better under Managed care.  You can read more here.)

But the dialogue between himself and a physician who posted commentary after the article is great fun...sharing with you, here:

• Van Gross, MD
• Miami, FL

People did not enter medicine to become Uwe Reinhardt chess pieces. If someone had asked the late great Stan Musial if he would have liked certain "recommendations" if not constraints placed on him so he could have better outcomes, he would have taken a left handed swat at said individual and tatooed his health care challenged body into the right field bleachers.
I know the analogy is imperfect but so is medical care. As a result, Reinhardt style comparisons of plans falls apart when individual variations for any given disease are acknowledged which prevent draconian pronouncements re: optimal care strategies for many different patients with diverse co-morbidities and cultural exigencies. Next year is 2014, not Huxley's 1984. If the idea is to begin the roll out of an army of "pawn medics" marching to the dictates of King Reinhardt, let the Medicare Advantage drum beat begin.

• Uwe Reinhardt
• Princeton, NJ

To Van Gross, MD:

I find it ironic that you mention Stan Musial, who played his game subject to many, many rules that constrained his game and whose game was judged by umpires he played it. Musial also undoubtedly got many recommendations over the years on how to improve the outcomes from his the way he played the game. In a sense, he played "managed baseball," although within the constraints of the game he still had enough leeway to play the game as best he knew how -- just as physicians under managed care still have enormous leeway on how to practice medicine. So I thank you for the analogy, Dr. Van Gross.

I recall debating the merits and demerits of alternative health systems with a physician some years ago when I asked him: "To make it short, describe to me your vision of the ideal health system." More physicians should be asked that question.

His response at the time was: "Physician and patient should be free to decide on the therapeutic response to a given medical condition, and the insurer should respect that and pay for it without questioning these therapeutic decisions."

The see the footprints that kind of apporach leaves behind, I encourage you and other readers to click on

http://www.dartmouthatlas.org/

and rummage around that website a bit.

Don't you love it??  Got to remember to read the commentary sometimes.....

Population Health in the US Pretty Much Sucks, at Least Relatively Speaking

The Institute of Medicine recently published a 378-page study comparing US health measures against other developed countries.  While similar studies have been done in the past, they have been largely focused on older populations.  The IOM's recent study focused on younger Americans as well - and the findings are just as bleak.

The study found that "Younger Americans die earlier and live in poorer health than their counterparts in other developed countries, with far higher rates of death from guns, car accidents and drug addiction" (this includes adults <50 years of age).  A particularly scary statistic:  the rate of firearm homicides was 20 times higher in the U.S. than other countries.  Oh, and by the way, we still have the highest rates of infant mortality and teen pregnancy.

The reasons for our poor health statistics can be blamed on a host of factors - both driven by our public health and health care system.  It's critically important to understand how both play a role; how it's just as important to reduce fragmentation in healthcare as it is to make sure people have health insurance, as it is to make sure people have access to healthy foods - and not guns.

One other interesting find:  "Americans who have not graduated from high school die from diabetes at three times the rate of those with some college." So our education system completely has a part to play....see how it's all coming together?  And how it's all falling apart?

When addressing our health problems, we need to look at things holistically, expand our thinking about what can be addressed with potential solutions.  For example, should we consider patient education sessions in a bundled payment for cardiac surgery, to promote healthy behaviors?  Public Health education in school?  Gun trade-in programs?  Or we could just move to Japan - and eat sushi with Jiro.

Read more here.

Goodbye, Pete Stark

Congressman Pete Stark is leaving the 113th Congress after 40 years of public service.  He is a bit of a health policy legend, probably most well-known for COBRA (which allows you to stay on your employer's insurance after you've left your job) and EMTALA (can't ditch the uninsured when they show up in the ER).

You can read more here.

ACA Impacts in 2013

Really liked this quick to read CNN article on PPACA impacts in 2013.  While most changes will not take affect until 2014, there are a few things to watch out for next year.  The big ones include:

1) Increase in Medicaid Provider payments - should be good news for docs
2) Health Insurance Exchanges "Go Live" in Oct. 2013
3) Insurers will have to publish easy to understand brochures describing their plans in a standard format; see sample here.

A "Bundled" Surgery: the Perfect Christmas Gift?

Want a free trip to Florida or California from your employer?  No problem!  Just break a leg (literally).

Kroger and Wal-Mart are among employers now sending their staff on all-expenses paid trips to get medical care.  As described in this LA Times article, costs for routine operations can vary widely depending on the care provider.  For example, Kroger found that one hospital in particular can provide hip and knee replacement surgeries at up to 15% lower cost than other providers - while maintaining the same quality in care.  This savings in cost more than covers the cost of trip expenses to receive care at the hospital, which is located in Irvine, CA.  Additionally, there is the element of predictability - employers contract with each selected provider to pay a fixed-rate per surgery, or "episode" of care - the oh-so-trendy "bundled" payment.

Are bundled payments the future of healthcare?  I just can't wait to find out - I know you feel the same way!

PPACA excluding Immigrants - Bad Health Policy?

My beloved healthcare bill isn't perfect, as most of the things I love aren't....sigh.

The White House recently disclosed that young immigrants now allowed to stay in the US will not qualify for health insurance under PPACA (neither Commercial nor Medicaid / CHIP public coverage).  This is a great example of bad policy stripping away the good intentions of another - these immigrants, now allowed to stay in the US with dreams of becoming productive citizens, will not qualify to purchase health insurance on exchanges and have access to affordable healthcare.

In my public health program, we learned all too often that personal health is very much linked to the ability to become a productive member of society...Ricardo Campos' story in the article is a great examples of this.

You can read the article here.