Archive for December, 2015

Health Wonk Review: 2015 Holiday Edition

Thursday, December 17th, 2015

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.

via giphy.com: http://work.neongsan.com/

via giphy.com: http://work.neongsan.com/

 

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.

via Ryan Todd at http://christmasgifs.org/artists/todd/

via Ryan Todd at http://christmasgifs.org/artists/todd/

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.

via gify.com: www.werobbanks.com

via gify.com: www.werobbanks.com

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

Brain Neong San http://christmasgifs.org/artists/san/

Brain Neong San http://christmasgifs.org/artists/san/

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.

James Curran http://christmasgifs.org/artists/curran/

James Curran http://christmasgifs.org/artists/curran/

 

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.

 

 

Kudos And Thanks To Work Comp Central’s Greg Jones

Wednesday, December 9th, 2015

Work Comp Central’s Greg Jones has relentlessly followed and reported on the Michael Drobot case in Southern California, a case that fairly oozes greed and sleaze.

For the uninitiated, Michael Drobot’s Pacific Health Corporation owned two hospitals, Pacific Hospital of Long Beach and Tri-City Regional Medical Center in Hawaiian Gardens. For around 10 years, he paid kickbacks to a number of doctors for referring spinal fusion patients to Pacific Hospital of Long Beach for surgery. In February, 2014, Drobot pleaded guilty to making the kickbacks, which are illegal, and for charging California’s workers’ compensation system, the U.S. Department of Labor and about 150 workers’ compensation insurers somewhere in the vicinity of $500 million dollars for the surgeries over the ten year period. At that time, we wrote about this with Honor Sold, Trust Betrayed: Unbridled Greed in California.

Drobot is also charged with bribing state senator Ron Calderon for his help in easing one of the SB 863 requirements, which we don’t need to go into here. Calderon has pleaded not guilty, and that case is moving through the system.

Throughout this sordid business, Greg Jones has been there, providing a valuable service with his spot-on reporting, most recently last week with his story (subscription required) that a number of the doctors who took the kickbacks, at $15,000 a pop, also had filed “more than 15,000 liens with a total claimed value of $93.8 million.” To get that story, Jones had to wade through what must have been a steamer trunk full of documents.

Personally, I owe a debt of gratitude to Mr. Jones. He found two errors in my post of 30 November, Workers’ Comp Fraud: The Michael Drobot Case Grinds On. I had written that the kickback scheme involved both of the Drobot hospitals. That was wrong. They only happened at Pacific Hospital at Long Beach. Also, I had written that Drobot had pleaded guilty to bribing Calderon. He did not. He is charged with doing it, and both he and Calderon have pleaded not guilty. Before Work Comp Central ran my post, Greg found the errors and made edits to correct them, for which I am grateful.

The Drobot case is complicated and it represents the bottom of the workers’ compensation bird cage. However, the solid reporting of Greg Jones shines an arc light on the sorry mess and will help to improve the system so that in the future the Drobots of the world will think twice about this kind of criminality.

 

 

New Health Wonk Review posted: Healthcare on Parade Edition

Thursday, December 3rd, 2015

Peggy Salvatore says that it’s beginning to look a lot like chaos — and her roundup of entries in this week’s Health wonk Review explain why: Healthcare on Parade Edition is freshly posted at Health System Ed blog. Peggy illustrates her post with images from the recent Macy’s Day Parade – she was very diplomatic in not making any analogies to hot air 😉

For another roundup, see Medscape’s The Year in Medicine 2015: News That Made a Difference

And in another perspective on 2015, some are calling it the year of the healthcare security breach.