Access To Care: Fact or Fiction?

Insurance is a huge piece of the overall health care puzzle. Make no mistake about that. As with any puzzle, there are many many other pieces that need to be put in place in order to complete it. eMax Health went undercover in the land of red tape and now share what they have found:

When interviewers posing as Medicaid patients called doctors’ offices that participate in the Florida Medicaid program, they were met in some cases by disconnected numbers, phone trees and time on hold before they could find out about scheduling an appointment.

How many of you, our readers, find that eerily familiar? With insurance (i.e. Medicaid) access to care is supposed to be assured. At least that is the common perception. Many low income families who rely on Medicaid would probably point out that it can often feel like access in name only.

Weekend and evening appointment times in some instances were scarce and some providers who said they were willing to take new patients proved to be less willing when they found out the new patient was part of the Medicaid program.

Hardly a surprise is you do some digging and see how low the actual reimbursement from Medicare to providers is. Do a little Googling, the results will probably shock you.

The study, which occurred in 2004, found that nearly 87 percent of the doctors in Florida’s Medicaid primary care case management program (MediPass) program told the interviewers that they would accept new patients, but only 68 percent said they were accepting new Medicaid patients.

While each of these problems might seem relatively small compared to the lack of insurance that keeps some patients away from regular care, Allyson Hall, Ph.D., and colleagues at the University of Florida argue that they can affect access to health care in significant ways.

“If an individual has a particularly difficult time getting in to see the usual physician, we could reconsider whether that physician is actually acting as a regular source of care for that patient,” the researchers write in the May 2008 issue of the Journal of Health Care for the Poor and Underserved.

The article goes on to examine aspects of the report in more depth, even bringing in some complementary data from a 2007 study done in Oregon. I predict that this is far from the last article we will see on this subject as election season progresses.

This issue is one that points out two major and related problems: the actuality of health care access and the reticence of providers who many times operate at a loss due to reimbursement rates from government plans. While profit may be vulgar to bring up, keeping a business (or medical practice) viable does require making more than you spend. For doctors this is a major sticking point. At the same time there is the plight of the low income American, lucky enough to have insurance but frequently stymied when attempting to use it.

Thank you for calling the United States. If you are experiencing a health care emergency please press "1"...

SOURCE: "Insured, Low-Income Patients Face Hurdles To Health Care Access" 05/08
photo courtesy of fuzzcaminski, used under its Creative Commons license

Kids Care, A Report Card

The subtitle of today's article du jour is, "Those that have the most access to insurance tend to have healthier children." This is hardly a shocking observation. What is shocking are the grades given to the various states of the U.S. by the Commonwealth Fund in their recent report U.S. Variations on Child Health System Performance: A State Scorecard. Steve Reinberg, HealthDay reporter for US News and World Report takes a look at the results:

According to the scorecard, if all states performed as well as the top few states:

• an additional 4.6 million children nationwide would have health insurance;
• 11.8 million more children would get their recommended yearly medical and dental check-ups;
• 10.9 million more children would have a "medical home" -- a regular source of care;
• 1.6 million fewer children would be at risk for developmental delays;
• and nearly 800,000 more children would be up-to-date on their vaccines.

Iowa, Vermont, Maine, Massachusetts, and New Hampshire are the top performing states, according to the report, while Arizona, Florida, Louisiana, Mississippi, New Jersey, Nevada and Texas are at the bottom.

As a Louisiana native, this is far from welcome, although unsurprising, news. With fifty states in the Union there are fifty different sets of standards being applied leading to a broad variance in results. Commonwealth Fund President Karen Davis stated in a Tuesday teleconference that more than a full third of American children receive care due to funding from the Federal Government and the states. SCHIP and Medicare were cited as crucial components in delivery of that care.

The scorecard took into account 13 indicators of children's health, including access, quality, costs, equity and the potential to lead a long and healthy life. While no state scored high on all categories, some regions surpassed others. For example, states in the Northeast and Upper Midwest often ranked higher in several areas, while the lowest rankings were in the South and Southwest, the report found.

Studies have shown that in states with high numbers of uninsured children, those children are less likely to get recommended health care, vaccines, dental care and regular checkups. These children are also at greater risk for developmental delays and infant mortality, Davis said.

But even in the highest-ranking states, quality of care falls short of goals, the report noted. In Massachusetts, the top-ranked state in quality, 75 percent of the children were seen by a doctor and a dentist in the past year, compared with only 46 percent of children in Idaho.

The conclusions reached by Davis, as related by Mr. Reinberg, are that states that do a better job of insuring their children, particularly those of low income, are among the most highly ranked overall for quality of care in the report.

For those who do not have the time or desire to dig into the actual report itself, Mr. Reinberg does a fine job of communicating the high points. The rest of his article covers comparisons of the highest and lowest ranking states, the concept of the "medical home," and more. Once again we find that the actual statistics of the current crisis in care are disheartening, but defining a problem is the first step towards rectifying it.

Continued studies such as these will help us to refine our focus on what areas need to change and how to properly go about it. We can create a system of universal care in this country. To paraphrase a line from an old television show, "We can rebuild it, make it better than it was. Better. Stronger. Faster."

SOURCE: "AStates' Scorecard Finds Big Differences in Kids' Health Care" 05/28/08
photo courtesy of M@rg, used under its Creative Commons license

The S.E.C. Gets Involved

The Securities and Exchange Commission has gotten involved in the ongoing health care debate, and is bringing shareholders along with them. Robert Pear at The New York Times reports:

The Securities and Exchange Commission, shifting its position, has told companies they must allow shareholders to vote on a proposal for universal health insurance coverage.

Shareholders, including religious groups and labor unions, have offered the proposal in an effort to draw the nation’s largest corporations deeper into a debate over the future of health care, fast emerging as one of the most important issue in domestic policy.

The S.E.C. has told Boeing, General Motors, United Technologies, Wendy’s International and Xcel Energy over the last several months that they may not omit the health care proposal from their proxy materials.

This move has been cause for surprise at many corporations, especially since the SEC allowed the exclusion of these materials in the past. Reactions have been varied. Opponents include Boeing and Reynolds American while others such as General Electric have adopted universal coverage as a principle. Many more are, or have been, negotiating with their shareholders in an attempt to find a workable middle ground. IBM and Wal-Mart are included in that number.

"We are working for a national policy that provides universal access to health care, and we do hold more than 30,000 shares of General Electric stock," said Barbara Kraemer, a Roman Catholic nun who is national president of the School Sisters of St. Francis. "As we pursued the proposal with G. E., the company requested a dialogue in lieu of the shareholder resolution, so we withdrew it. The dialogue was productive, resulting in G. E.’s public endorsement of the Institute of Medicine principles."

Labor unions and religious groups said they intended to broaden the proxy campaign by bringing in more pension plans next year. If the dialogue between companies and shareholders were to continue, as expected, it could help bridge the divide that has frustrated earlier efforts to cover the uninsured.

It seems that the conflicted nature of views on health care reform continues to hold sway when looked at from this angle. Mr. Pear offers several examples that show the array of self-interests at work in this strata of the health care crisis. From the fears of Reynolds American that funding for change would come out of their tobacco based business in the form of cigarette taxes, to the strange proxy battle that United Health (insurer of over 70 million people) engaged in recently, he covers the whole array.

It will be worth watching to see what comes out of the SEC in relation to this topic over the next several months. Whichever way they jump, it will have far reaching ramifications, especially after January 20 when a new President enters the Oval Office.

SOURCE: "S.E.C. Backs Health Care Balloting" 05/27/08
photo courtesy of takomabibelot, used according to its Creative Commons license

Unmanaged- Economics of Health Care

There is a book excerpt on the Forbes site for John Hammergrin and Phil Harkins' new book, Skin in the Game. I bring this up because Mr. Hammergrin brings up a lot of the same points that our own Mr. Halvorson addresses in Health Care Reform Now! and two of them share many common conclusions. Here are a few small teasers drawn from the excerpt for your perusal:

What's becoming better understood is that our health care crisis is fundamentally a business problem. The system is overstrained and is breaking down due to outdated information technology (IT); poor application of the basic principles of market economics; overall inefficiency in terms of work flow, care delivery and the spreading of best practices; a lack of transparency around quality and cost; and blocked access to making informed consumer choices.

Don't get me wrong: I 'm not assigning blame for any of these built-in flaws. They are a result of the way our health care system has developed into a set of parallel cottage industries that until recently have never had a real chance of being integrated into a seamless, efficient industry. Doctors, hospitals, insurers, suppliers and the government have all run their shops separately and distinctly from each other, so that literally one part of the system cannot talk to another in any trustworthy, efficient, error-free way.

He then goes on to address another huge factor -- the opaque, disjointed, and incredibly irritating nature of dealing with health care as a patient. Anyone who has had so much as a simple blood test can relate to that one. Take your average doctors visit as an example. First, Mr. Hammergrin touches on the universal experiences that go along with you as you navigate the experience: long waits (no matter how far in advance you schedule), brief and unsatisfactory time with your physician, and the additional time and confusion that result if a prescription needs to be filled afterwards.

Mr. Hammergrin states that the average doctor actually only has 12 minutes to spend with you once you are finally in the same room. I would say, from my own experience, that sounds about right. Then comes the clever bit:

The economics of the entire interaction are a complete mystery to you. Your doctor's visit will cost you a co-pay fee up front, if you have insurance, but you won't know what the examination really cost until you get the bill months later. If you have insurance, you probably don't bother to check that statement, but if you do, the numbers and codes are almost impossible to unravel, and you would get little comfort knowing how much confusion is rampant behind the scenes in those back offices. The doctor charges one thing, the insurance company pays something else, and chances are, it takes three exchanges back and forth before the final claim is settled, and you are lucky if you do not receive calls or notices drawing you into the dispute.

Small wonder. There are 1.5 trillion claims each year, and a full 30% of those claims have errors, while 15% get lost. Twenty-five percent of claims are still paper-based, and it costs $20 to $25 to manually process them.

Wow. In what other industry is this sort of margin acceptable? It is simply stunning to think that in a field as important as health the level of accuracy and efficiency is so dismal.

Consider how strange this would be if it were applied to any other economic transaction. Imagine you go to Macy's to buy a tie or blouse. You want to pay for the item, but the price isn't marked. You ask the salesperson, who says, "Sorry, we have to mail you the bill." You insist you want to pay right now, and the salesperson's manager says, "We just can't do it that way. The price is different for different people, and we don't know what your credit card company or bank will allow us to charge you." Four to eight weeks later you get the bill, but you have no idea if you've been charged the right price.

Perversely incentivized, disorganized and top heavy with complexity, the American health care system is truly in crisis. That is something that there is wide consensus on. Despite the precedents set in the past there is an urgent need to reboot the entire system and bring it into the 21st Century. While advances have continually improved the ability to care for various medical conditions (Jenner and Jarvik come immediately to mind), the ability to deliver that care to those who need it has been mired in bureaucracy and confusion.

It is time for a change! Check out the rest of Hammergrin's excerpt here.

SOURCE: "Unmanaged Care" 05/23/08
photo courtesy of bdunnette used under its Creative Commons license

Transparency: The Government Angle

One of the big issues with American health care is the lack of ability to compare prices and care quality between care providers. As many people step forward in favor of market driven solutions -- a very good idea in many respects -- this sort of information is crucial to making informed decisions about said market. As a matter of fact many of the posts in our archives here on the blog are concerned with efforts to create this sort of transparency. Now the federal government, in the form of the U.S. Department of Health and Human Services, is embracing that stance.

Cherie Black over at the SeattlePI takes a look:

The U.S. Department of Health and Human Services is running ads in both Seattle daily newspapers Wednesday showing consumers how to compare services and quality of care in area hospitals by using a new Web site.

The ads, which are running in more than 50 other newspapers across the country, promote Hospital Compare (hospitalcompare.hhs.gov), a Web site that scores 26 quality and patient satisfaction measures at nearly 4,000 hospitals nationwide.

This should be an interesting website launch to follow. The media blitz should get them a lot of traffic, and I am sure that soon there will be a lot of commentary floating around the net.

Using metrics like price of procedure, volume (how many of a single procedure are performed), percentage of patients who received anitbiotics an hour before surgery, and how many patients received help when they asked for it the site seems to cover a lot of ground. It is exactly this sort of information which can help create the informed market needed for a free market solution to gain traction.

More transparency in health care is a good thing, said Dr. Ed Walker, medical director at the University of Washington Medical Center, and this site shows how physicians are having more open conversations about errors and prevention.

"I bought my last car by going to Consumer Reports and looking at the comparisons," Walker said. "We have a populous who expects us to be like Consumer Reports, and while that may be a bit ahead of our time, we still have a good balance."

Indeed. This is the 21st Century, people are accustomed to being able to look up anything by simply spending a moment at their keyboard. Instant gratification is something that Americans have always had a penchant for. Google and the Internet have brought that attitude to the world of information and people are becoming highly dissatisfied with the delays endemic to almost any interaction with our health care system. In that respect this is a good thing.

But Walker cautioned consumers to realize that no one measure defines a hospital, and some measures can be imprecise. For example, some measures, such as whether patient received antibiotics before a surgery, are easily defined -- there's a surgery checklist to consult or an empty bottle from the pharmacy as evidence. How long a patient had to wait to see a nurse after he or she was called is more subjective.

"How soon a nurse responded is influenced by a lot of things, including how many patients they have at one time," Walker said. "They weigh the needs of the patients simultaneously -- but we should aspire. These are our patients telling us how we're doing, and we should listen to that."

All in all, I expect this to be a major move forward. Only time will show how well they are able to implement and manage this service, but more transparency and more available information are always good things!

SOURCE: "New Web site compares hospital care: Services, costs and patient satisfaction are all measured" 05/21/08
photo courtesy of edans, used under its Creative Commons license

Reform and Technology

It is no secret that much of the discussion about health care solutions hinges on technology. Efficiency improving, cost reducing tech such as electronic medical records are rightfully brought up in any serious debate on the subject.

With that in mind, today I'm going to point you towards a recent piece in ZDNet's healthcare section by Dana Blankenhorn which discusses the application of Moore's Law to medical reform and technology:

Moore’s Law, the idea that technology gets faster-and-faster faster-and-faster, is not applied often enough to health care. Regulation frustrates it, constantly. We want to audit every data transfer, or place expensive hurdles before any improved device.

Moore’s Law is the force behind the biggest trend in health care, personalized health care. Instead of guessing about what you should do based on test results when you get sick, doctors prescribe lifestyle changes beforehand, based on genetic knowledge.

It’s Moore’s Law which enables Google Health to let you have your personal health records, free. And it’s Moore’s Law which enables Microsoft to store and move all a hospital’s records through its Amalga system.

It’s Moore’s Law which enabled the human genome to be decoded early this decade, and is now enabling the start of decoding how genetics codes for proteins.

It is a significant conundrum, and not an unfamiliar one. Complete deregulation of any big business usually has unwanted consequences, but the speed at which the tech advances is orders of magnitude more rapid than attempts at regulation or legislation. Yet it is this rapid advancement creates better options at lower costs.

As our nation struggles to find a workable solution to the current health care crisis, technological advancements consistently present options that can increase systems thinking and efficiency, improve quality of care while driving down the cost of said care, and enable a more preventative approach.

A workable middle ground needs to be created between regulation and scientific advances. As a nation we desperately need it!

SOURCE: "Moore's Law and Health Care" 05/20/08
photo courtesy of Jurvetson, used under its Creative Commons license

Credit Cards, Health Care, and McCain's Vision

Robert Gordon of Slate offers a prescription of comparison as a cure for rhetoric. While examining the health care proposals of Senator McCain, he examines a similar situation in recent history: the treatment of the credit industry in the late 1970s.

Let's start with his recap of the way that credit-card business migrated to the states that had the least regulation:

Until the late 1970s, South Dakota and Delaware didn't have an outsized share of the credit-card business. Banks had to obey the interest caps of the states where borrowers lived. So, for example, loans to New York residents were always subject to New York's limits on interest rates. At 12 percent back then, and with high inflation, these laws sharply limited profits on credit cards.

Then in 1978, the Supreme Court said banks should follow the rate cap in their home states. This meant that as long as a credit-card company relocated to a state with a higher interest-rate limit, the company could lend to borrowers anywhere under that higher limit. Following the court's ruling, Citibank chairman Walter Wriston offered Gov. Bill Janklow a deal: If South Dakota lifted its rate cap altogether and formally invited Citibank to the state (as federal law required), the banking giant would move its credit-card operations to South Dakota—along with 400 good jobs.

The bill was introduced and passed in the space of a day. Soon after, Delaware lifted its cap, too. Voilà, South Dakota and Delaware became the hosts of most credit-card companies.

An excellent illustration of the fact that one needs to looks not only at the proposed actions to be taken, but also at the ramifications of those actions. This brings us to the Senator's statements about "allowing families to purchase insurance across state lines." Seemingly sound upon first glance, the actual repercussions bear scrutiny.

McCain argues that different states' regulations "prevent the best companies, with the best plans and lowest prices, from making their product available to any American who wants it." Although he hasn't given details, his supporters say that he favors an approach, endorsed by President Bush and championed by McCain's Arizona colleague John Shadegg, that would allow insurers to choose the state laws under which they are regulated. (I e-mailed the campaign about the specifics of McCain's approach and didn't hear back.) An insurance company that chose to be regulated under Arizona law could sell policies in New York without following New York rules. Arizona, like most states, lets companies charge what they want to people who are sick—or simply deny them coverage altogether. Under Shadegg's bill, insurers wouldn't even need to pick up and move their operations; it would be enough to file some paperwork with a state insurance commissioner and pay that state's relevant taxes.

Now the classic Libertarian argument about credit-cards would probably be that no one forced anyone to get a credit card in the first place. However, that argument is incomplete. It fails to take into account the usurious practices that tend to flourish in an environment where consumer protections and regulation are minimized to this extent.

With the individual market for health care, the libertarian argument fails on its own terms: Sick people can't get coverage they can afford. It's as though the rafts are reserved for people who already have life preservers. Americans with pre-existing conditions—cancer, asthma, diabetes, and the like—would need to pay even more than they do today. Through no fault of their own, more of them would end up without insurance. Meanwhile, insurers would improve their own profits by offering targeted policies to people with the fewest health expenses. As with the history of credit cards, it's Robin Hood in reverse. Apart from the obvious injustice, this approach could add to spiraling health costs. The sickest 10 percent of Americans are already responsible for 70 percent of the nation's health expenses. When more such Americans go uninsured, skip checkups, and land in the emergency room, they end up costing taxpayers more.

It is hardly shocking that once again we come full circle to one of the points in George C. Halvorson's book Health Care Reform Now!. Chronic conditions are the lion's share of health care expenses in the U.S. The looming financial specter of the emergency room casts a very long shadow across the health care crisis. Despite President Bush's famous remarks last July (“The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America. After all, you just go to an emergency room.”) this approach does nothing but drive overall costs upward while overextending the ER's to the point of massively increasing wait times and decreasing quality of care. Besides, when was the last time you know of someone going to the emergency room for chemotherapy?

There are many measures that can be taken to help pull our nation out of its downward spiral, but they all require careful thought and practical implementation. Both regulation and deregulation and powerful things and both have far reaching effects that will ripple across America. We need to be decisive yet act with care, especially those of us who are getting older.

Check out the original article and see what you think.

SOURCE: "Reverse Robin Hood Why is John McCain wrong on health care? Think credit cards." 05/19/08
photo courtesy of SoggyDan, used under its Creative Commons license

Home, Sweet Medical Home

If you have been following health care issues, there is a high probability that you have already run across the concept of a "medical home." It's a concept that has been bandied around frequently and and as often as not seems to be surrounded by hype. Alice Dembner at The Boston Globe takes a close look at the concept of medical homes in a recent article. The prognosis seems quite positive:

The future of primary care medicine is taking shape in Somerville's Union Square.

Doctors quickly answer patients' questions by e-mail and phone.

Visits are available from early morning into the evening and Saturdays.

The medical team tracks patients' needs so closely that they know when a diabetic misses a critical blood test or an asthmatic needs a new inhaler.

Across the nation, patients are so frustrated by lack of access to their doctors that they are going to drug-store clinics for basic care. And primary care doctors are so harried that they are abandoning their practices in droves.

The "medical home" being created at Union Square Family Health and at many doctors' offices across the nation is an attempt to provide an alternative. Such a doctor or nurse-practitioner-led team practice is designed to offer patients care when and where they want it and to give the team the money, the tools, and the time to do more than triage.

While this may sound too good to be true, research indicates that this could well be the wave of the future. Removing the perverse incentives or per visit billing, providing the added efficiency of electronic medical records, and resurrecting the "personal touch," so often bemoaned due to its lack, the medical home seems to solve a variety of the issues plaguing medical delivery in the modern age.

At the Union Square office, doctors offer one-stop shopping for physical and mental care, provide group as well as individual visits, and recently began encouraging patients to e-mail their doctors and view portions of their computerized medical record through a secure website.

Cidalia Moura, a 57-year-old Somerville factory worker, learned about the computer access from her doctor last month. The convenience of renewing prescriptions online is very appealing, she said, as are the evening hours. But what matters most, she said, is the time with her doctor and nurse, and feeling truly cared for.

The stereotype of Marcus Welby style doctor is considered outdated, a relic which has gone out of style along with house calls. That personal relationship with one's doctor is invoked with a wistful nostalgia by many people who feel as though they are on a carousel spinning from one specialist provider to another, none of whom they experience a personal connection with.

Not only does centralizing care help recreate that sort of connection, but it may also be able to amend the payment scheme which created the disconnect in the first place.

At Massachusetts General Hospital, Dr. Allan Goroll is raising private money to test a medical home model where doctors are paid per patient, instead of per visit, to encourage comprehensive care and ease the pressure on physicians.

"Doctors now are on a hamster treadmill," said Goroll, an internist who cofounded a primary care training program at Mass. General decades ago. "They have to maximize visits to keep the lights on in a practice. There isn't much pay for thinking, talking to patients, and coordinating, just for doing things."

"Patients have the sense that the doctor is rushed, not available. Physicians feel poorly and patients are unhappy. It's a downward spiral." [...]

For a total cost to the healthcare system of just $500 to $800 per patient each year, he said, doctors could run an office that included a nurse practitioner, nurse, medical assistant, receptionist and part-time social worker and nutritionist. Patients would not have to pay extra, he said. To discourage the team from withholding care, a portion of the fee would be paid only if quality goals were met.

The full article is well worth the read. It contains a number of short case studies as well as data on several different trial runs of the medical home concept being piloted across the U. S. It also brings up and addresses some of the issues with such a transition, such as cost of embracing electronic medical records, etc.

I believe this could be the wave of the future, what do you think?

SOURCE: "A more welcoming model for care" 05/19/08
photo courtesy of Michael L. used under its Creative Commmons license

CEOs Talk National Health Care Reform

Whitney Jackson, a reporter for Medill News Service, had an interesting article in the Austin Weekly News recently in which she took a look at the outcome of a recent meeting of movers and shakers in the Health Care Industry:

CEOs from many leading health organizations met in Chicago Tuesday to unveil their consensus plan for national healthcare reform, which calls for increased accessibility and affordability, as well as quality care for all Americans.

The executives, representing the Healthcare Leadership Council, are set to discuss their proposal with U.S. Senate and House committee leaders. The executives said they hope it will impact the Democratic and Republican political campaigns and decisions of the next president.

"I don't think any of [the presidential candidates] have it right," said Denis Cortese, president and CEO of Mayo Clinic. "None of them are really addressing the issue of what we're going to do with the total [health-care] delivery system-how are we are going to generate [quality]? How we reward it?"

This is a very important question considering the perverse nature of financial incentives in the current system -- once again returning us to the refrain "9,000+ billing codes for procedures, no teven one for a cure." Quality of care, not quantity of care, is an area that needs emphasis right now. As Cortese said in his interview:

The most broken aspect of U.S. health care, he insisted, is that "we are paying the most amount of money for bad outcomes, bad safety, bad service, no integrative [and] coordinated care. That's partly why our expenditures are just going up and up and up."

It was not just Cortese speaking up, though. The press conference last Tuesday included a variety of luminaries from the health care field including Mark Neaman, President and CEO of Evanston Northwestern Healthcare; Colleen Conway-Welch, Dean of the Vanderbilt School of Nursing; Mary Grealy, President of the Healthcare Leadership Council; John Hammergren, Chairman and CEO of McKesson Corp.; and Ronald Williams, Chairman and CEO of Aetna.

Points focused on during the press conference included the following concepts central to the reform effort: Every American should have access to health coverage; improve the quality of care through a combination of innovation and sharing of medical knowledge; a fundamental change in the financial incentives used within the industry.

A sound game plan in my opinion.

SOURCE: "Health care industry CEOs offer reform plan: Executives call for more insurance options for consumers" 05/14/08
photo courtesy of Mike Schmid, and used under its Creative Commons license

Insurance: A Christian Alternative?

It is simply amazing the things that turn up when you start digging around on the Internet. Sites and blogs that you have never heard or conceived of turn up on Google with the most interesting stories. Case in point is today's subject: Health Cost Sharing Ministries.

You see, I was doing research on health care costs and I stumbled upon Ken Walker's piece on Church Central. It seems that some members of the Christian Community have cooked up their own solution to dealing with cost of care and insurance issues. It is, indeed, an interesting one. Walker describes it thusly:

I'm a member of Christian Care Ministry (CCM), which I've found to be reliable and pleasant to deal with. I also like its emphasis on healthy living as an alternative to facing high health costs (something I'm taking especially seriously after my surgery.)

However, I'm not trying to advertise for CCM as much as promote these plans. In recent years I've talked to three different self-employed Christians who all pay $1,100 or more a month for health insurance. As I told one, "If someone said that's what I had to pay for coverage, I'd tell them I'll just have to take my chances."

The other two major plans I'm aware of are Christian Healthcare Ministries and Samaritan Ministries. While there are variables, each operates on the same principle: Christians helping other Christians share health care expenses. Their foundational verse: "Carry each other's burdens, and in this way you will fulfill the law of Christ." (Gal. 6:2, NIV.)

Although none fits the legal definition of insurance, they still have similar deductibles and guidelines. Sometimes that has brought oversight or even legal snarls with state insurance regulators, but thus far the ministries have prevailed.

The insurance collaboratives are an interesting twist on dealing with health care costs. More of a cost sharing co-op than anything resembling insurance as we know it, they are a concrete example of the lengths to which modern Americans have to go in order to in order to take care of themselves.

The mere fact that actions like this are needed proves that sweeping reform is of utmost importance!

SOURCE: "Christians sharing health care costs alternative to insurance" 05/12/08
photo courtesy of maccanti, used under its Creative Commons license

Health Care Costs, Bad Diagnosis for Providers As Well As Patients

I have often written about the rising cost of care and how it affects modern Americans. I have tried to steer my audience towards articles that help illustrate the conundrums faced by people who must put off needed health care in favor of paying rent or having groceries.

Not this time. Today, I'm going to share a commentary column from New Jersey, one which looks at another vital aspect of the cost of care: how it affects hospitals and care providers. In this case it is the cost of charity care, as Dr. Micheal Bleiman points up in his recent article for the Ashbury Park Press in New Jersey:

By law, New Jersey hospitals are required to treat all patients, whether they can pay for the services provided or not. In a majority of cases, patients without insurance are not able to pay and then qualify for charity care. Therefore, the cost of the emergency department visit, the possible admission, medications, chemotherapy, radiology services, surgery, nursing, meals, doctor consultations, etc., are provided without reimbursement to the hospital.

State law requires, based on a set formula established by Gov. Corzine's administration, that hospitals be partially reimbursed for a small fraction of the charity they provide. Under Corzine's proposed 2009 budget, the state will no longer reimburse some hospitals for charity care. He decided to break one of his own laws. It must be nice to be governor.

This is a big deal.

Southern Ocean County Hospital in Stafford provides more than $3 million in charity care a year. The state reimbursed the hospital $450,000 last year. Next year — nothing.

This is yet another symptom of our national health care crisis. No matter what your perspective is on profits in the health care industry, the fact that is as cold and hard as an operating table is that even if you have the money and have insurance, it will do you no good if the hospital you need cannot afford to stay open.

Imagine New Jersey legislating no more food stamps. Instead, supermarkets must provide qualifying families with free food. Imagine no Kids Care, the state insurance program for needy children. Instead, physicians must treat any family that qualifies and pharmacies must provide all medications free of charge. Imagine your vehicle is due for inspection, but the state closes the inspection stations. Instead, service stations and car dealers are required to inspect vehicles for free to those families that qualify.

I think the good doctor's analogies are good ones. This is part of the equation not frequently seen by those who are not in the medical (and related) fields. But wait, you say, what about non-profit hospitals and providers? Well, Dr. Bleiman wastes no time addressing that angle of the issue:

Most hospitals in New Jersey are not for profit. This means they are not responsible to investors for a return on their investment. However, they do have to pay their employees, buy pharmaceuticals and buy equipment. And they must reinvest to keep their facilities and equipment safe and up to date. They are responsible for providing the best care possible to their neighbors. Our patients demand excellent health care.

How is a private institution supposed to provide a service but not be allowed to charge for it or get reimbursed for it? Logic says sooner or later, the quality and available services have to suffer.

Thankfully, the majority of New Jersey residents don't have to worry about health care until they need it — especially in an emergency. For example, when you're driving 90 mph on the Garden State Parkway without a seat belt and your SUV rolls over, you need a well-staffed hospital that is not cutting corners just to keep its doors open.

More food for thought. Makes you really wonder doesn't it? Hospitals across the U.S. expend far more resources than they are reimbursed for in treating Medicare/Medicaid cases. Somewhere, the bottom has to drop out. Cost shifting efforts like the ones being addressed in the above excerpts simply delay the final collapse while they attempt to shift the blame for said collapse to someone else's purview.

SOURCE: "Don't burden hospitals with full brunt of charity care costs" 05/14/08
photo courtesy of Robyn Gallagher, used under this Creative Commons license

"Nationalized Health Care"

It is a phrase used a lot in reference to the plans proposed by both Sen. Hillary Clinton and Sen. Barrack Obama should they attain the post of President. As Kevin Freking of the Associated Press points out in a recent article, it is an inappropriate usage of the phrase:

Last week, Sen. John McCain, the likely Republican nominee, described his challengers' health care plans as a "move closer to a nationalized health care system." But that's a stretch. To nationalize means to transfer ownership or control to the government. There's still a vast distance between what the Democratic candidates have proposed and nationalized health care.

Clinton and Obama aren't proposing government hospitals or government doctors. They want people to have health insurance, and they want people to be able to choose from a variety of policies. The menu would include private plans as well as an option similar to Medicare. Tax breaks would help lower- and middle-income people pay their monthly premiums.

In addition, proposed employer involvement and the rescinding of Bush administration tax cuts for the wealthy assure that there will be others besides the government paying into the program (whichever it ends up being) once it is enacted.

Such a system would continue the split system that the U.S. has when it comes to health coverage. The elderly, poor, disabled and many veterans would continue to get care paid for primarily by the government. Others would get coverage from private companies, usually through their employer, or through the Medicare-like option.

"Their approach is not taking any other country's system. It's building on what we have in the U.S," said Karen Davis, president of the Commonwealth Fund, which conducts health research.

Freking goes on to provide an illustrative comparison between our system here in the United States and those of Great Britain and Canada. He finds that while many more here in the U.S. chose to skip seeking care out of financial fear, residents of the other two countries tend to have much longer waits when specialist care is needed -- waits that are often a month or longer.

He also touches on economic side effects of the high cost of American health care, such as the fact that stateside manufacturers find it harder to compete in the global marketplace due to the high and rising cost of coverage.

"That's why it costs less to build a car in Canada than in the United States because you've got a bunch of money tied up in health insurance," said Steven Lewis, a Canadian health consultant.

As usual, Freking prescribes a solid dose of information for his readers, including an interesting observation about the one commonality that people in all three countries share. I'll let you read the article to find out what it is....

SOURCE: "Insurance model follows American tradition" 05/10/08
photo courtesy of *clarity*, used under its Creative Commons license

Dr. Rocky White: Evangelical, Conservative, Single Payer Plan Advocate?

Much of the discussion about health care reform in the national arena is centered around the continuing debates between the two Presidential hopefuls of the Democratic Party: Senators Hillary Clinton and Barack Obama. With cost of care an issue of escalating prominence, and groups like the AFL/CIO releasing findings that show their membership believes the American health care system to be broken on a fundamental level, this issue is one whose importance cannot be overestimated.

One option noticeably absent from both candidates' conversations is that of a single-payer solution. A species of solution was endorsed last December by the American College of Physicians, the largest medical specialty organization in the U.S. Amy Goodman of Democracy Now! takes a stab at the subject matter in an interview that appeared in AlterNet. In that interview she speaks with Dr. Rocky White, an evangelical from a rural conservative background who is a proponent of a single-payer system.

And as I began to study and to look at state policy and federal policy and going back -- if you want to understand our health care system, you have to go back fifty or a hundred years to see how we evolved into this. You know, there wasn't some mad scientist in the 1940s who devised this horrible system that we have today. It was just a matter of evolutionary process, so to speak. But as I began to study that and to try and assimilate what it was that was going on, I began to see some very disturbing trends. Part of the reasons that we got to where we're at today are multiple. There's not just one "this is what happened." And as I started to weave that together, I began to say, "Jiminy Christmas! This thing is really screwed up!" And now I'm beginning to understand the health care system very well, not just our group, but as a whole.

And then I began to ask myself, what are we going to have to do to fix it? And so, obviously, single-payer was not even something that I would have even considered ten years ago. In fact, ten years ago I didn't even know the word "single-payer" existed. And so, as I started to look at that and I looked at different ways that we could fix this whole thing -- I mean, you talk about subsidies, expanding Medicaid, all of that -- I began to realize that the only way that we're going to fix this system is we're going to have to put everyone on a Medicare-like system. In order to truly fix the system, we're going to have to put everyone into one single risk pool, we're going to have to share that risk, and the most efficient way to do that is through the tax system.

It's a highly unusual perspective compared to others from a similar background -- a fact that Dr. White was painfully aware of as he researched his position.

And I was very sheepish about the whole thing. I mean, here I am, a Republican, thinking about nationalizing health care. It just went against the grain of everything that I stood for. But you have to remember something, Amy: I didn't come to those conclusions with lofty ideals of social justice. It was purely from an economic standpoint. This is the only way that we're going to do -- be able to fix this and do it efficiently.

Go check out the interview. It is three pages of great food for thought. It is also an example of the type of thinking we need now in order to be able to enact positive reform, thinking that sets ideology aside in favor of facts and groundwork.

The health care crisis is one that does not care if its victims are conservative or liberal. It takes no notice of skin color or church affiliation. Ask the 47 million uninsured.

SOURCE: "Evangelical Doctor Touts Better Health Care Plan Than Clinton, Obama" 05/06/08
photo courtesy of Pink Moose, used according to its Creative Commons license

Salazar Speaks Out

On Tuesday, the United States Senate Finance Committee held a hearing entitled "Seizing the New Opportunity for Health Reform." Goals and principles of health care reform were addressed along with a reaffirmation that reform efforts should be comprehensive, not incremental, and that quality health care should be available to all citizens of the United States.

Senator Ken Salzar of Colorado, a member of the Committee, was one of those who addressed the hearing. Here are some excerpts from his address brought to us via the full transcript on Trading Markets.com:

"While many in our nation go without care, it certainly is not due to a lack of health care spending. In 2005, health care expenditures in the U.S. totaled over $2 trillion dollars - nearly 15 percent of our gross domestic product and the highest spending level of any developed nation by far. So I ask myself - with so much of our money being spent on health care services, how can so many of our people lack access to affordable, high quality care" It is a dynamic we all struggle to understand, and I look forward to hearing the panel's thoughts on this during today's discussion.

"When I go back to Colorado and talk to the people in my state, their number one health concern is the cost of care. The price they must pay drives every decision they make when it comes to their personal health - which is certainly not the way we should be making life-altering decisions for our friends and loved ones. For those people without insurance, the problem is obvious - they cannot afford to pay the staggering "sticker price" for health care services out of their pocket - and they rely too heavily on emergency services which are inefficient, expensive and less than ideal. But the growing plight of the uninsured causes difficulty for individuals with insurance as well, as many of the costs of treating the uninsured are passed along to all consumers and result in increased premiums and cost-sharing obligations. This often means that even those with insurance cannot afford to seek treatment because they cannot afford their high deductibles and copayments, creating a vicious cycle of unmet health care needs.

As someone who has had recurring health issues of various sorts, I can attest to this. Many times I have had to forgo seeking professional care because it was a choice of that or rent. (Writers don't make very much unless they happen to be Stephen King or Tom Clancy.) On one or two occasions it ended up with me having to go to the emergency room, vastly increasing the expense both for myself and or others.

Now I have insurance thanks to my wife's job at a local university, although that does not improve matters much from they way they were before. Several hundred dollars a month go towards coverage, but attempts to use it reveal a labyrinth of paperwork and bureaucracy that often seems designed to prevent our use of the policy.

"As I listen to discussions of health care reform, I can come to only one conclusion - our goal must be universal access to affordable, high quality health care for every person in this country. While I am sure that my colleagues on the Committee may have differing perspectives on how we can achieve this goal, I am convinced that there are common principles that can tie us together and hope that former Secretaries Shalala and Thompson can help us identify those areas. Prevention, health technology, primary care, chronic care coordination - these are concepts that we know hold value - and the time has come for us to delve into the details of incorporating them into our health care system and realigning the system's incentives to make sure they are addressed."

Indeed, these are all issues that George C. Halvorson brings up in his book Health Care Reform Now! as being critical to effecting substantive, positive change in our current "non system." Let us hope that Sen. Salazar finds many kindred spirits on the Senate Finance Committee.

SOURCE: "Senate Finance Committee Takes First Step to Discuss Broad Health Care Reform Solutions" 05/07/08
photo courtesy of Phil Roman, used under its Creative Commns license

Kaiser Rolls Out HealthConnect

Pacific Business News reports:

Kaiser Permanente said Monday that all of its 8.7 million enrollees in nine states, including Hawaii, and the District of Columbia have access to HealthConnect, an outpatient electronic health record Kaiser says is the world's largest of its kind.

Officials at Oakland, Calif.-based Kaiser said all of Kaiser's 13,000 physicians nationwide now have electronic access to patients' medical records in the system's 421 medical offices and clinics.

But Kaiser still has a ways to go on the inpatient side. Officials said 13 of its 36 hospitals (34 of them in California) have installed the EHR software, giving 3.2 million enrollees the advantages of an inpatient EHR system. Some 14 hospitals are slated to do so this year, including 13 in the Golden State and one in the Portland, Ore., metropolitan area.

The remaining nine hospitals, including the Moanalua clinic on Oahu, will follow in 2009 and early 2010, said Kaiser spokeswoman Ravi Poorsina.

Four billion dollars worth of electronic health records going online. This is a major milestone on the path to reform. It is also the latest evidence of the massive steps taken by Kaiser since 2004.

"Electronic medical records are a cornerstone tool for improving quality and safety in health care. Doctors should have all of the information about all of their patients all of the time. Only a computer and an EMR can do that work," George Halvorson, chairman and CEO of the nonprofit Kaiser Foundation Health Plan and Hospitals, said in Kaiser's May 5 statement.

From eliminating unnecessary duplication of medical tests to coordination of care, this rollout of EHR capabilities is already noted by Kaiser as vastly improving care delivery. 75% of Kaiser clinicians find it a more efficient and effective communication tool, while over 85% find that it makes administering medications safer and more accurate according to statements.

SOURCE: "Kaiser finishes phase of health records project" 05/05/08
photo courtesy of takomabibelot used under its Creative Commons license

Can I Get That Cat Scan as a JPEG?

Thanks to Thomas Hoffman at ComputerWorld, we have this little gem of a story. It is part of a series on the top projects of the year by the Top 100 IT leaders, and with good reason!

FirstHealth of the Carolinas Inc. began replacing its film-based radiological technology with an online digital capture and storage/retrieval system in late 2005 to enable up to 300 of its radiologists and physicians to instantly access clinical images from any location, says Linda Briggs, director of application support.

That 2005 initiative was only the humble beginning. The people behind the program had much bigger plans -- plans that are reaching fruition thanks to their determined efforts. CIO David Dillehunt has had big plans from the beginning and, more importantly, the dedication to see them through. The big success is First Health's Picture Archiving and Communications System (PACS):

PACS, which went live in March 2006, is providing FirstHealth with several clinical and IT-related benefits. For starters, FirstHealth has been wrestling with year-over-year data growth of 100% since 2004. With a mix of more than 650 applications to manage, the organization saw a digital storage architecture as a means to increase its operational efficiencies, reduce costs and improve patient care.

With more people currently on the planet than have existed in the entire history of earth combined, this sort of growth is hardly shocking. Capacity to handle the sort of increases future years will bring is an important concern for any project of this nature and proposed scope.

The digital imaging system has also enabled FirstHealth to slash its annual film budget from around $800,000 to about $50,000 this year, says Mike McCarty, FirstHealth's director of imaging.

$750,000 in savings? This is proof positive that electronic medical records can put a much needed dent in the cost crisis that American health care is experiencing. That is a hefty number no matter who is counting.

The PACS system relies heavily on storage and networking software from NetApp Inc. NetApp NearStore systems enable high-speed, disk-to-disk backup while serving as a permanent archive for the PACS images. NetApp SnapMirror software works with NetApp Snapshot technology to replicate all critical business and patient data among FirstHealth's three hospitals. Meanwhile, NetApp FlexVol storage virtualization software dynamically provisions and reallocates the organization's storage resources as needed.

Real-time access to patient information has helped improve the quality of patient care by enabling FirstHealth physicians to make faster decisions about treatment, says Drusi Smith, a senior clinical analyst at the organization. That in turn is helping FirstHealth reduce the length of patient stays in its hospitals, Smith says.

Once again, we see the multiple advantages that electronic medical records bring to the table. Regional efforts such as the PACS covered here are an important step forward, hopefully into a future where we achieve true health care reform!

SOURCE: "Health care goes digital with instant image access" 05/05/08
photo courtesy of brainsik, used according to its Creative Commons license

Cost Factor. Again.

I know it keeps coming up. I really wish it did not.

The cost of health care keeps floating to the surface of the ongoing national debate. While the subject of universal coverage is frequently on people's lips, it is often the cost issues that place people among the 47 million uninsured. As we proceed to wade through the point and counterpoint of the ongoing race for the Oval Office this subject gets touched upon with increasing frequency.

In a Letter to the Editor published in The New York Times, Jennifer Baron writes:

Ultimately though, universal coverage, regardless of when a mandate is introduced, cannot succeed until health care becomes affordable. To achieve this we must recognize that costs are only a symptom, albeit an intractable one, of a far deeper problem overshadowed by the wrangling over universal coverage: the dysfunctional structure of our health care system.

Only after reshaping the way health care is paid for and delivered will costs sustain and decrease. And only then can universal coverage become a reality.

In the Kansas City Star's MidWest Voices Steve Winn writes:

New reports this week underscore the critical need to rein in health care costs. They are damaging the economy, squeezing American families and worsening the federal government’s fiscal problems.

And as many health care experts have observed, Americans aren’t even getting their money’s worth. The country ranks well behind many other countries on health measures.

As someone who has felt this crunch personally in the past, I can understand easily how this issue is beginning a slow boil. With millions being wasted on antiquated paper based systems and other outmoded approaches there is plenty of room for improvement and reform.

SOURCE: "Reshaping Health Care" 05/01/08
SOURCE: "Thrsday Editorial: Fixing the Health Care Squeeze" 05/01/08
photo courtesy of stopnlook, used under its Creative Commons license

With This Ring I Do Thee Insure

As a relatively recently married man, I remember well the vast array of concerns and issues that revolved around both the decision to get hitched and the process itself. One factor that did contribute somewhat to our decision was the fact that my wife had health insurance through her work at a major university. As a freelance writer and blogger, I did not.

While for us it was a tertiary concern, a recent study shows that a small but significant percentage of the population base their decision to marry on the issue of health insurance. Ricardo Alonso-Zaldivar of The Houston Chronicle shares the results of this intriguing survey:

In a poll released Tuesday, 7 percent of Americans said they or someone in their household decided to marry in the past year so they could obtain health care benefits via their spouse.

"It's a small number, but a powerful result, because it shows how paying for health care is reflected not only in family budgets, but in life decisions," said Drew Altman, president of the Kaiser Family Foundation, which commissioned the survey as part of its regular polling on health care.

Now as I said, it was one factor among many for my wife and I. Not a deal breaker or deal maker, but worthy of consideration. That said, I know two couples that did finally decide to tie the knot because of health care and insurance issues. A situation that is vexing to say the least. Maybe I am just a romantic at heart, but I do not think that health care should have to be a factor when deciding whether or not to purchase a wedding ring.

It's not just marriage that is being impacted either:

The survey found that the costs of health care outranked housing expenses, rising food prices and credit card bills as a source of concern.

Of those surveyed, 28 percent said they had experienced serious problems because of the cost of health care, nearly tied with 29 percent who had problems getting a job or a raise.

The state of health care in the United States is truly at a crisis point. What this nation needs is health care reform, and we need it now.

SOURCE: "Poll: 7% of Americans marry for health insurance" 04/29/08
photo courtesy of babasteve, used under this Creative Commons license