We’re happy to host this year’s holiday edition of Health Wonk Review. But before we get to the meat and potatoes, we like to check in on The Santa Index to see how the Big Guy is faring. We’re happy to report that he got a raise of 3.8% or $3,130, bringing his annual wage to $143,054, which seems pretty paltry when you consider that “he’s a manufacturing executive, professional shopper, sleigh driver, delivery person, list checker, and heads a customer service department for nearly 2 billion children.” Insure.com calculates his life insurance needs but we learn nothing about whether he’s getting health coverage through the ACA or not. He engages in some very hazardous work, has adopted some bad health habits — too many cookies, driving too fast and lack of seat belts, to name a few — and has a quite a few risk factors, so he’d likely benefit from the lack of restrictions on pre-existing conditions.
Affordable Care Act
All is calm, all is bright? Let’s get to the controversies right out of the gate:
At Health Affairs Blog, opponents of the Affordable Care Act propose an alternative plan and to enact major reforms to the tax treatment of employer-sponsored health care, Medicaid, Medicare, Health Savings Accounts, and other areas. In their post Improving Health And Health Care: An Agenda For Reform, authors Joseph Antos, James Capretta, Lanhee Chen, Scott Gottlieb, Yuval Levin, Thomas Miller, Ramesh Ponnuru, Avik Roy, Gail R. Wilensky, and David Wilson say that their plan would “reorient health care policy away from bureaucratic regulation and toward the preferences of patients and consumers.”
However, at least one of our wonks has a bone to pick with one of the study authors. At ACASignups.net, Charles Gaba calls out Avik Roy in a recent post for data “disingenuousness” in his critiques of the Affordable Care Act, and again in a follow-on post for lack of acknowledgment of the problems.
In another matter that many use to signify the death knell of the ACA, United Health has made headlines with its rumblings of pulling out of the exchanges. Would such an exit mean that the that the ACA isn’t viable or is United just not up to the challenge of fierce competition? At Health Business Blog, David Williams offers his perspective in his post United pulls out of ACA exchanges: Should we care?
At Colorado Health Insurance Insider, Louise Norris looks at whether or not open enrollment for health insurance plans should end by December 31 and finds she’s recently changed her mind. Previously, she supported consumers having a chance to review and change auto-renewed plans if they learn that changes resulted in a plan that isn’t quite what they expected. While she still supports as much leeway as possible in plan selection during open enrollment, she explains how the system can be gamed and what the long-term implications for adverse selection and rate volatility would be if open enrollment continues after the coming year’s plans have already started to take effect.
In another hotly contested ACA issue, the Supreme Court has agreed to hear Little Sisters of the Poor Home for the Aged v. Burwell, the latest legal challenge to Obamacare’s birth control mandate. Amy Lynn Smith explains what a win for the plaintiffs could mean for millions of Americans in her post at healthinsurance.org Blog, How millions could lose birth control coverage.
At InsureBlog, Hank Stern is thinking about men’s issues. He reports that the new “healthcare freebies” list is out but notes that “once again men’s health is omitted. But they still get to pay.” Check out his post Still sexist after all these years.
How Docs Get Paid
At Managed Care Matters, Joe Paduda says that changes in the way that providers are reimbursed are painful, but they are necessary. He offers a brief explainer of different methodolologies and tells us the three things we should know about what’s happening with provider reimbursement
How will Medicare reform provider payment going forward? Will they tie payment to quality? If so, how will benchmarks be defined? What about providers who participate in multiple quality incentive programs? In Reforming Medicare Provider Payment, Jason Shafrin of The Healthcare Economist investigates these questions and more.
At The Population Health Blog, Jaan Sidorov looks at the Limits of Financial Incentives for Docs. He examines a recently published study showing that financial incentives did not have as big an impact on physicians as commonly imagined. Jaan argues that’s because physicians live by more than bread alone.
Compliance, Data and Legal Matters
David Harlow takes his role in “preventive law” seriously in reminding all members of the “regulated community” to get their affairs in order. At HealthBlawg, he posts about recent enforcement activity by “the federales,” which shows that they mean business when it comes to HIPAA compliance and enforcement: Third Time’s a Charm: Triple-S and its Data Breaches. David says this should serve as yet another reminder that when they eventually kick off the long-promised audit program, covered entities and business associates are likely to feel the sting.
Remember the good old days, when times were simpler, and health technology was all about electronic patient records? Not today. Peggy Salvatore points out that world of health technology is about telemedicine, wearables, data collection and privacy. In her post at Health System Ed Blog, she looks at the challenge of how the health system sould harness all this unstructured patient data: Challenge: Consumer Healthware and the Glut of Unstructured Patient Data.
Calling medical malpractice “bloggers crack” or the gift that keeps on giving, Bradley Flansbaum dedicates his post at The Hospital Leader to examining the results of the recently released Medscape 2015 Malpractice Report, and he his colorful interpretation: More Med Mal Sustenance
Faulty Ethics at Play
Roy Poses is a health care rabble rouser and we mean that in the most positive way. At Health Care Renewal, he’s shining a light on “highly unethical” medical trials that involved multiple academic medical centers, including some of the most prestigious in the US – yet which received scant media attention. The studies involved sleep deprivation on physician-trainees. Trainees previously worked up to 36 consecutive hours, which new rules now limit to 16 hours. This increased the number of patient hand-offs, so the study goals were ostensibly to assess a method to reduce the hand-off problem. But Roy makes the case that the trials may have violated several major components of the Nuremberg Code, the set of principles for ethical research that were developed in response to Nazi medical-trial atrocities. Learn more at Drinking the Managerialists’ Kool-Aid? – Why Did Medical Educators Launch Trials of Increased Sleep Deprivation of Physician Trainees Apparently in Violation of the Nuremberg Code?
Finally, we have our own submission, a post by Tom Lynch in which he extends kudos to Work Comp Central’s Greg Jones for his ongoing reportage of the Michael Drobot case. If you are unfamiliar with this half billion dollar fraud case in which docs were given kickbacks for referring patients to surgery and legislators were bribed, you can catch up at this post and an earlier one, Workers’ Comp Fraud: The Drobot Case Grinds On.
See you in the New Year
This is the final edition of HWR for 2015 so we extend our best wishes for t holiday season. Our wonkers will be back bright and early in the new year: Look for a Jan. 14 edition by Hank Stern at InsureBlog.