Clinics Without Doctors

In Washington state, an experiment in accessible health care has been launched. Multicare Express has opened two clinics in the back of local Rite Aid stores, an approach that seems to have legs despite the absence of actual medical doctors in those clinics.

Via Rob Carson of The News-Tribune:

For a flat fee of $59, an advanced registered nurse practitioner will usher you into a 9-by-14-foot exam room (immediately, in most cases) and conduct a routine exam. Lab equipment is limited but adequate for diagnosing common illnesses such as strep throat, earaches, flu and urinary tract infections. The clinics can handle pregnancy tests, adult immunizations and sports physicals.

No appointments. No waiting rooms. No insurance requirements.

No doctors, either, but the ARNPs are fully equipped to diagnose most basic problems and write most prescriptions.

“It’s a new way for patients to enter our system, and it’s a convenience for consumers,” said Kristopher Kitz, a MultiCare business strategist. “Primary care facilities in Pierce County are at capacity, and this is a way to ease that burden.”

Clinics in retail outlets have been opened before -- there are close to a thousand of them across the country -- but despite many advantages, their numbers are actually experiencing a slight drop over this past year. Analysts within the health care industry have stated that the worsening economy combined with the fact that investors did not truly understand the commitment of finances needed to make it work have caused the recent reduction.

Enter MultiCare, an established hospital system that is bringing electronic medical records among other advances to the equation. The fact that they will accept most forms of insurance including Medicare and Medicaid is a major point in their favor especially considering the already reduced pricing.

MultiCare will be holding grand openings at the clinics on August 15 and 16 with free espresso, sodas and an appearance by Tacoma Rainiers’ mascot, Rhubarb.

SOURCE: "CLINICS OPENED AT TWO TACOMA-AREA RITE AIDS- Multicare Express an experiment in health care" 07/30/08
photo courtesy of dpade1337, used under its Creative Commons license

Doctors Reviewed Online

One of the growing trends online that has been spreading like a virus is that of sites that allow people to provide feedback on goods or services they have received. The ability to have an independent platform for both praise and complaints is refreshing to many. After all, most people trust "word of mouth," and the relation of personal experience far more than any sales pitch. It is the trend du jour, as sites across the net will demonstrate. There are websites for rating and reviewing all kinds of products and services ranging from cars to college professors, and now there are a whole new generation that focus on health care providers.

Via Shari Roan of The Atlanta Journal-Constitution:

They're saying what they think about the state of health care and, more specifically, the doctors who provide it. Dozens of Web sites that permit people to rate, review, spin or flame their doctors have sprung up in the past year, operating in much the same way as online services that help people find hotels or plumbers.

Patients and site operators say the trend is good for consumers and good for health care. Thoughtful doctors, they say, will provide better customer service because of the feedback, and the bad ones will no longer be able to hide. Many physicians say the reviews on RateMDs.com, Vitals.com, DrScore.com and other sites are skewed by disgruntled patients and are unfair, pushing some doctors to near-ruin after a single post.

Ms. Roan provides a lot of solid background and quotes from authorities that are both pro and con. She also includes a bullet list of the six top sites for the rating and reviewing of health care professionals.

Since legally a doctor cannot publicly discuss a patient's health care, they are at a bit of a disadvantage as far as dealing with detractors on the Internet, to say the least. It remains to be seen how much impact reviews like these will have on bad doctors, and likewise how much damage might be done to the good ones. In the past, I have worked in the service and retail industries, and in both it was very much a truism that 99% of people will never comment unless they have a complaint. This tendency has potential to skew these sites, so it will be interesting to watch the evolution of checks and balances develop as they evolve.

SOURCE: "Doctors are 'in' for online evaluation" 07/30/08
photo courtesy of Geishaboy500 used under its Creative Commons license

Health Care In The Mall?!?!

One way of accessing health care in Prince George's County, MD, in the near future will be by emulating the tradition of suburban youth in America: going to the mall.

Oveta Wiggins at The Washington Post reports:

Under the plan, the county would partner with private retail owners to renovate or build spaces where customers could, for example, buy a pair of shoes in one end of the mall and get a mammogram or a physical in another. The partnership would be paid for with public and private dollars.

A feasibility report presented to the County Council a month ago looked at four different malls in the Beltway chosen due to their size, vacancy rates and unstable tenant base. After reviewing the report, some county officials have stated that they see this sort of development serving multiple purposes. On one side of the equation, adding medical services to malls would generate jobs and tax revenues for the county. On the other, access to medical services could be brought within reach of people in under served areas. The perception of a win-win scenario seems quite likely to be accurate. The funny thing is, this is not a new idea:

Hunter Interests, which was commissioned by the Maryland-National Capital Park and Planning Commission to do the report, noted that hospitals introduced the "medical mall" concept about 20 years ago to bring health care closer to residential neighborhoods. Groups of doctors followed, opening clusters of medical services in abandoned retail spaces.

Still, there are only about 50 medical malls nationwide, Hunter said.

In my opinion, this is a highly logical move. In addition to the reasons that Ms. Wiggins presents in her report, I also think it is indicative of the ongoing consolidation of services I see occurring in many of the "big box" stores. Now you can often find notaries, banking and other services in these sort of venues. It makes perfect sense to integrate health services into the overall trend. After all, accessibility is one of the huge and looming issues in the current debate.

Transportation imposes limits on many people's access to health care, as well as a variety of other services. Bringing medical care to malls, which are usually easily accessible via public transit, vastly increases the array of people who can make use of said facilities.

SOURCE: "One-Stop Spot for Health-Care Needs - Officials Say 'Medical Malls' Could Make Services More Accessible, Convenient" 07/27/08
photo courtesy of Joe Shlabotnik, used under its Creative Commons license

Slate Brings US The Health Care Slugfest!

Slate Magazine, an online daily owned by The Washington Post that has attracted numerous awards brings us a really useful collection of links to information from all sides of the health care debate.

As Slate's writer, Timothy Noah, puts it:

If you want to learn the current parameters of the political debate over health care reform, scrutinizing the plans proposed by presidential candidates Barack Obama and John McCain will get you only so far. A sharper picture of where the battle lines are drawn is starting to emerge from two new lobby campaigns recently created by two key opposing groups.

He then goes on to provide capsule descriptions of the Insurance Industry's Campaign for an American Solution and the liberal movement's Health Care For America NOW!

It is, as blog posts often are, a quick read. A plethora of hyperlinks will take the online investigator to a variety of pertinent source material on both sides of the issue, and does so with the usual patented Slate cheekiness.

SOURCE: "Health Care Reform: The Slugfest Begins - Meet the interest groups that will decide the fate of medical insurance." 07/22/08
photo courtesy of d. billy, used under its Creative Commons license

Checkup: Reducing Costs By Paying More

You've all been there. Sitting in a sterile waiting room while you fidget. Finally hearing your name called, allowing you a few precious moments with the man in the white coat. While you are waiting, time seems to drag, but once ushered into the presence of a physician it suddenly seems to kick into overdrive. You can hardly believe that you were in and out so quickly.

It begs the question: can adequate care really be given in the rushed format in which most doctors see their patients?

One answer offered also claims to be a route towards decreasing medical spending. In short, the idea of paying doctors more to take time with their patients (a permutation of the Medical Home concept) to prevent massive costs down the line. It is a grand experiment on the part of a group of state and federal government agencies in conjunction with a number of insurers.

Milt Feudenheim at The New York Times gives us two pages of analysis and commentary on the idea. Here is an illustration of the difference taken from that article:

For want of a careful examination by a primary-care doctor, Mr. Williamson became one of countless Americans each year whose unidentified or under-treated illnesses escalate into medical conditions with catastrophic personal and economic costs. Besides incurring $30,000 in hospital bills paid by his employer’s insurer, Mr. Williamson had to stop working as a customer service representative at Philadelphia Gas Works and go on Social Security disability, at a current cost to taxpayers of $1,900 a month.

With Mr. Williamson’s new doctor, such an outcome would be much less likely.

“I give him my heart and diabetes readings by e-mail and phone, without getting up out of my chair,” Mr. Williamson said. “I can get better directions, at the very moment I need them. It’s life-saving.”

His current internist, Richard Baron, is one of more than 100 physicians in metropolitan Philadelphia taking part in the experiment, which is being conducted jointly by some of the region’s largest insurers. Dr. Baron still gets a fee of only about $64 for each office visit. But his five-doctor group will also receive $200,000 to $300,000 this year beyond their regular fees to keep better track of their 8,400 patients.

“We are trying to do more e-mail care and telephone care, which we haven’t been paid for in the past,” Dr. Baron said.

Insurers are conducting similar pilot projects in at least a half-dozen states, in experiments involving thousands of doctors and nearly 2 million patients. Many more are in the planning stages, at the urging of health policy experts and employers that provide medical benefits.

The big government health care programs, Medicaid and Medicare, are also studying the concept. A Medicaid experiment already under way in North Carolina saved the government program in that state about $162 million in 2006. That was 11 percent less than the state would have spent under the old system of reimbursement, according to an audit by Mercer, a consulting firm.

This looks like an idea that might have legs. It is axiomatic that more careful and comprehensive care should drastically reduce the longterm costs of health care. Whether this approach will yield a solution or not is something only time will tell, but the logic is sound.

Certainly a set of initiatives to watch!

SOURCE: "Trying to Save by Increasing Doctors' Fees" 07/21/08
photo courtesy of Papalar, used under its Creative Commons license

Mr. Halvorson Goes To Washington, Recap

Last Friday I wrote about George C. Halvorson's trip to Washington to give testimony to the Senate Finance Committee. Today, I would like to do a small follow up on that post.

Commentary and reporting on Mr. Halvorson's Senate testimony provided by Andrew Noyes on NextGov:

Kaiser Permanente CEO George Halvorson's testimony came as several legislative proposals intended to create a national system of electronic medical records are moving through Congress. Achieving such an overhaul would be daunting, and electronic medical records alone are not sufficient to provide optimal care, Halvorson said.

He called for a special support system that would analyze data from interconnected networks and give physicians prompts to support consistent care delivery and a stand-alone care registry for those Americans who will not have immediate access to integrated health IT. Once a fully computer-supported system is in place, the nation should aim to reduce asthma, congestive heart failure and kidney failure by 50 percent, he said.

Mr. Noyes then proceeds to provide capsule reviews of the responses from the Senate. From the cautious skepticism of Finance Chairman Max Baucus to additional testimony by CBO Director Peter Orszag, he provides a nice summarization of events.

Under Mr. Halvorson's guidance, Kaiser Permanente has become recognized as being at Leading Edge of Health IT, at least according to a piece in U.S. Insurance News a few weeks ago. His focus on the billions in savings, as well as the improvements in treatment it would usher in provide the impetus for his quest to implement IT solutions.

This is far from a new position for Mr. Halvorson. This interview in the San Francisco Chronicle back in 2003 show an almost prescient awareness of the direction we, as a country, have been going as the health care crisis gets worse with each passing month.

What we need is health care reform, and we need it now!

SOURCE: "Panel weighs challenges of adopting health IT overhaul " 07/17/08
SOURCE: " Kaiser Permanente on Leading Edge of Health IT" 06/23/08
SOURCE: "On the record: George Halvorson Kaiser CEO looks at the high cost of health care" 11/16/03
photo courtesy of mdu2boy, used under its Creative Commons license

Community Prevention For $10 a Year

For $10 annually per person we, as a country, could invest in community-based disease prevention programs could save the U.S. $2.8 billion each year in health care costs. The savings could take effect in as little as a year or two according to a study released Thursday by the Trust for America's Health.

I first discovered this in the Baltimore Business Journal, where they point out:

The U.S. could save more than $16 billion annually within five years, or a return of $5.60 for every $1 invested. In that five-year time frame, D.C. could save $57.2 million, Virginia could save $385.1 million and Maryland could save $332.2 million.

The report focuses on disease prevention initiatives that do not require medical care, such as increased access to affordable, nutritious foods, increasing sidewalks and parks in communities, and raising tobacco tax rates.

The study found that reducing Type 2 diabetes and high blood pressure rates by 5 percent through such programs could result in $5 billion saved in heath care costs in five years.

Prevention is a loud chorus in the song of health care. While some things may not at first seem to be health care issues, I think we can all follow the logic of needing access to healthy food in order to properly nourish our children. Personally, as a smoker, I'm in favor of the higher tobacco tax. It might help me finally quit.

The study itself is well worth a look, and includes a breakdown of projected returns on a program of this nature broken down on a state by state basis. This excerpt from the report itself helps illustrate why this sort of strategy is important and can produce results that can alleviate the financial stresses that are crippling our system and bankrupting our citizenry:

"Health care costs are crippling the U.S. economy. Keeping Americans healthier is one of the most important, but overlooked ways we could reduce these costs," said Jeff Levi, PhD, Executive Director of TFAH. "This study shows that with a strategic investment in effective, evidence-based disease prevention programs, we could see tremendous returns in less than five years -- sparing millions of people from serious diseases and saving billions of dollars."

In Health Care Reform Now!, George C. Halvorson lays out the numbers on just how much chronic conditions and preventable health issues comprise of our overall health picture. I'll give you a hint. The number is well over half.

SOURCE: "Prevention for a Healthier America
Investments in Disease Prevention Yield Significant Savings, Stronger Communities" 00/00/00
photo courtesy of PublicResource.org, used under its Creative Commons license

George C. Halvorson and The Senate Finance Committee

On July 17, 2008, George C. Halvorson gave testimony to the Senate Finance Committee on the role of health information technology in improving health outcomes. The full text of his testimony is available in PDF format from the Senate Finance Committee's website.

If you would just like the highlights, but prefer to get them from someone a little more removed from Mr. Halvorson than we are, you should check out the post made by Condor over on the Searlings Got Plowed Blog. (I like to get multiple sources and perspectives so I feel compelled to offer them to our readers when I can.)

Here is one small excerpt that really grabbed me. Mr. Halvorson, in the course of detailing what Kaiser has already implemented in the way of electronic health records, shares the following letter received by his company. It's a letter that shows the human impact of these technological advances:

This last example was highlighted for me by a recent letter from a member that puts a human face on these statistics.

Early last year, I came to your facility to have a foreign body removed from my eye. I visited your Ophthalmology Department and your competent staff dealt with this minor emergency. What made this visit so meaningful was my interaction with your nurse after my visit with the doctor. In addition to giving me some after visit instructions, she noticed in the computer that I needed a mammography exam. I had been reminded before but I tend to be too busy to take care of my own health. This time the nurse was very insistent. She even made me an appointment so I could walk in and get the exam within the hour. Since I did not have to wait too long, I had the exam done that day. Well, they found a mass in my right breast and it was cancer. I have gone through chemotherapy and radiation therapy and today I am cancer free.

I am convinced that I am alive today because of your organization’s focus on my total health. My interaction with your entire health care system has been nothing but positive. I am especially appreciative to the young nurse who took the time to convince a stubborn old lady to take responsibility for my health.

Thank you for giving me many more years to thrive.

This letter describes a simple act by one of our nurses, but it was possible only because the nurse had access to that information, acted on it, and was part of an integrated health care system that encourages this series of events.

If you are at all interested in the application of technology in this fashion, I highly advise taking a look at the full text of his testimony. If it is food for thought you are looking for, this is a banquet!

Download PDF here.

SOURCE: "Testimony of George C. Halvorson Chairman and Chief Executive Officer Kaiser Foundation Health Plan and Kaiser Foundation Hospitals Before the Senate Finance Committee" 07/17/08
photo courtesy of Mr. George Halvorson

Gasoline: The New Health Care Cost

There are many factors that add to the cost of health care for the modern American. Now, as we ramp up for the Presidential race, another line item has been added to the bill: gasoline. With the shortage of qualified nurses and the current freeze on Medicare cost increases, this is an issue of increasing import.

Via Gary Gosselin's article in The Oakland Business Review as syndicated through MLive.com:

Home health care workers and businesses are adjusting services and spending as they adapt to high fuel prices.

Michigan home care workers make 11.5 million visits a year, driving an estimated 161.3 million miles, according to the National Association for Homecare & Hospice.

With many of the home care workers performing nonmedical functions, the pay is relatively low, in the $8- to $10-an-hour range.

The article includes interviews with numerous providers of home health care that detail many of the cutbacks being enacted in order to combat the high price of gas. From employees who can no longer afford to make it to work to additional surcharges on health care to cover fuel, it paints an uneasy picture of reduced services for the increasingly large ranks of elderly who require home-based care. As more and more Baby Boomers reach advanced age and gas prices continue to skyrocket, the impact of fuel prices will extend its reach farther and farther.

Home health care is predicted to increase thirty percent between now and 2012. This is on top of the increase from only 633,000 workers in the industry during 2000 to a whopping 913,300 in 2007. The spike in numbers here reminds me of the prices I see at the pump daily, steadily rising. With an overall 50% increase in gas prices since this time last year the trends do not seem heartening.

I guess a house call is out of the question?

SOURCE: "Some predict shakeout in Michigan as fuel prices hit home health care" 07/17/08
photo courtesy of Svadilfari, used under its Creative Commons license

Remote Moitoring Device Gets FDA Approval.

Technology is often a topic here on the Health Care Reform Now! blog. Electronic medical records and the coupled aspects of savings and efficiency that they bring to the table are a central part of George C. Halvorson's approach to reform. Today, I would like to talk about a new innovation, one which will help fill in the blanks on medical records, electronic or otherwise.

I am speaking of the Intel Health Guide PHS6000, a nifty little gadget that takes over a lot of the monitoring and communications needs of chronic care. Catherine Paddock over at Medical News Today has a nice little review of the device:

Intel's Health Guide has an online interface that allows clinicians to monitor and manage patients remotely. The interactive device which can be attached to blood pressure monitors and other home based equipment, sends vital sign data to the clinician, shows patient reminders, presents multimedia educational content, and allows patients and clinicians to communicate by video conference and email. It looks like a medium sized chunky laptop with a touch screen.

I think we could be seeing something big kicking off here. Ease of use studies have been underway for sometime now and projections show the gadget hitting the market around the end of this year. Once this and devices like it become commonplace, it should help put a hefty dent in cost of care by eliminating unneeded office visits as well as by providing up to the minute data for treatment.

SOURCE: "Intel's Home Care Remote Monitoring And Communication Device Gets FDA Approval" 07/14/08
Press release photo courtesy of Intel

Health Care Access: Steadily Deteriorating Since 2003!

AMedNews calls itself "The Newspaper for America's Physicians." A trade publication for Health Care Providers, they tend to cover topics pertinent to this blog. Hardly shocking.

This time they bring us a bit of news that is shocking, or at least highly disturbing, especially in light of many topics we have covered here in the past. The article's subtitle is an excellent summation: "One report finds that millions more insured patients are delaying or not getting care, while another shows a spike in 'underinsured' Americans."

Doug Trapp brings us the findings and analysis:

One in five Americans -- 59 million people -- reported delaying or not getting needed health care in 2007, up from one in seven in 2003, found a June 26 Center for Studying Health System Change report. "We've been tracking access to care for 10 years, and this is by far the biggest change that we've seen in those 10 years," said Peter Cunningham, PhD, study co-author and senior fellow at the center. Of those reporting an access problem last year, 43.5 million had insurance, compared with 25.9 million in 2003.

In a similar vein, the number of underinsured -- steadily insured people who paid significant out-of-pocket costs for health care -- reached 25.2 million people in 2007, up from 15.6 million in 2003, according to an analysis by the Commonwealth Fund published online June 10 in the journal Health Affairs.

As always when examining the state of the current system, the hard numbers are disheartening. According to Mr. Trapp's reporting, a significant number of those uninsured are among those who earned 200% of the federally determined poverty level.

Access is an issue, now more than ever:

The center's report found growing access problems for children. Among all children, 3.9% had an unmet health care need in 2007, up from 2.2% in 2003 and 3.2% in 1996-97. Cunningham said children's access likely is being affected by the higher insurance costs their parents are facing.

Some people with access problems had trouble making or getting to medical appointments, the center reported. Fifty-eight percent of adults with access problems said the health system was a reason. Of those, 28.6% said they could not get to a doctor's office or clinic when it was open.

"This report is really a warning about seismic change in our health care system," said David Colby, PhD, vice president for research and evaluation at the Robert Wood Johnson Foundation, which funded the center's study. "With each passing year, more Americans are really falling behind when it comes to getting the medical care they need."

The reports he refers to show that cost of care, that consistent bugaboo, once again rears its ugly head as the culprit. Larger deductibles, tighter spending limits, and other factors being introduced on the insurance end of the equation are creating a prohibitive environment for health care access. This is something pointed towards by prior studies, but now is documented.
In addition, the Commonwealth Fund report noted a 62% jump in uninsured adults during the 2003-2007 period studied. I cannot help but wonder if those individuals are included in the oft-quoted number of 47 million uninsured Americans.

The article contains a wealth of information and documentation including a supplement at the end which presents the statistical data as a series of graphs and additional links to source data and online discussions.
SOURCE: "Health care access problems surge among insured Americans" 07/21/08
photo courtesy of FuzzCaminske, used under its Creative Commons license

Union vs. McCain: Round Two

My last post on this blog talked about the recently launched ad campaign levied against Sen. McCain by the American Federation of Government Employees (AFGE). In that post we looked at an example of the YouTube ad and I offered ruminations on the way that the union is leveraging old and new media to get the word out.

Today lets take a look at what the Annenberg Political Fact Check has to say about the content of those ads. (I really hope these guys pay a lot of attention to health care during the upcoming six months. Their objective analysis of the facts behind the spin is usually indispensable.) Here is one small excerpt from their extensively documented breakdown:

The AFL-CIO, in documentation it provided to FactCheck.org, cites four specific votes as support for this allegation. Three of them were against Democratic amendments to the annual budget bill in 2004, 2005 and 2006. And all of them failed along party lines in a Republican-controlled Senate. But in each case, McCain later supported different amendments to increase veterans' health benefits, either on the same day or the following day.

Specifically, in 2004 McCain voted against an increase of $1.8 billion, but an increase of $1.2 billion passed by unanimous consent. In 2005 he voted against an increase of $2.8 billion, then voted for a $410 million increase. And in 2006, he voted against a $1.5 billion increase, then voted for an $823 million increase.

In the increasingly complex flurry of opinion, fact, spin, and rhetoric that surrounds this issue it is more vital than ever to dig down to the roots of any claims made. This is true for both the views you support and the ones that you disagree with.

Think of it like electronic medical records vs. the current system. In the current system the details of a patients health issues can be fragmented across several different hard copy filing systems, each offering only an incomplete picture of the case. The confusion and possibility for mis-diagnosis is high, just as it is when bombarded by the (often ad hominem) arguments and spin surrounding the debate. Just as electronic medical records, once implemented, will allow reconciliation of data from disparate sources and act as a preventative against mistaken assessment of the situation, use of fact checking resources like the Annenberg Political Fact Check can help you reconcile the claims with the realities as the national discussion continues.

SOURCE: "AFL-CIO Falsely Attacks McCain" 07/10/08
photo courtesy of World Economic Forum, used under its Creative Commons license

Union Says McCain Approach to Health Care is Wrong

Market Watch ran an interesting press release last Wednesday concerning Senator McCain's proposed idea of distributing health vouchers to American military veterans at private, for profit providers. This is a move viewed by many as the beginning of a dismantling process for the Veterans Health Administration (VHA).

Via Market Watch:

This week, the American Federation of Government Employees (AFGE) launched a nationwide radio ad campaign raising serious concerns about Senator McCain's commitment to veterans' health care. In addition to the radio ads, AFGE, which represents employees in the Department of Veterans Affairs, launched a Web site, www.fundtheva.com, and a series of YouTube ads featuring union veterans voicing their concerns about McCain's controversial veterans health care platform.

The AFGE is not being bashful about their views. Not only that, but they are also being quite strategic in how they express them. Radio has a phenomenal reach, not having to concern itself with the digital divide it extends into houses, work sites, and the autos of commuters across the nation. YouTube also boasts an incredible reach, as has been proved repeatedly in the early months of campaigning this year. Between the two, the AFGE will be able to spread their message far and wide.

Here is an example of one of the YouTube ads:


Over the next several months we will be seeing an amazing array of reports, studies, propaganda, and spin concerning health care as the competition for President heats up prior to election day. Here on Health Care Reform Now! we will try to keep you abreast of developments as they happen.

SOURCE: "Union Representing VA Workers Launch Nationwide Radio Campaign, Web Site and Viral Videos for Full VA Funding" 07/09/08
photo courtesy of DOD Via PingNews, used under its Creative Commons license

From Jersey To Arizona: Reform Legislation

From the Upper East Coast to the dry expanses out West, health care reform is making waves. As the ad campaign of Health Care For America Now! begins to roll out (see my earlier posting), the state governments of both New Jersey and Arizona are in the news because of their actions on this topic.

In the Northeast, we have New Jersey Gov. Jon S. Corzine who just signed a health insurance reform bill into law that includes an expansion of NJ Family Care, a source of low cost insurance options for those who are in need.

Via the Philadelphia Business Journal:

The legislation increases the number of low-income families who qualify for the program and phases-in mandatory coverage for all children in the Garden State. [...]

Corzine wants to see all New Jersey residents have health insurance by 2011.

"While there has been much national dialogue about universal health care, here in New Jersey, we're actually doing something about it," he said.

That quote should be making its rounds of the Internet soon. As always, only time will reveal whether the legislation will prove effective or if it's all just more sturm und drang. The concept is sound, but implementation seems to frequently fall victim to funding problems. Let us wish them well in their efforts. Any steps towards universal health care on the state level have the virtue of testing the viability of the approaches espoused allowing us to form a better picture of what a uniquely American system of universal care will end up looking like.

Now let us shift our view to Sen. John McCain's home state of Arizona. Howard Fischer of Phoenix's East Valley Tribune brings us an interesting story about a battle on the floor of the State House of Representatives.

House Minority Leader Phil Lopes, D-Tucson, said voters should reject an initiative being pushed by some doctors and others to constitutionally prohibit forced enrollment in either private or government-run health insurance programs. The measure also would bar any law which limits an individual's choice of doctors.

"They are trying to protect the system that I think everybody, most people, think is broken," Lopes said.

While Lopes has an interest in stopping this controversial legislation because it would disallow his own universal health care plan for the state, he still has some valid points. If Sen. Obama wins the race for the Oval Office, his proposed mandates, while only involving children, would be directly at odds with this proposed law.

Lopes supports a single payer approach centralizing the payment for health care services through the government. His opponents present an argument that resonates with many Americans, one of independent choice.

But Jeff Singer, a Phoenix surgeon and one of the architects of the initiative, said the measure is not aimed at any specific plan or concept. Nor is it aimed at halting what he said is necessary reform of health care.

"We just want to make sure that whatever kind of health care reform is ultimately instituted, that it doesn't infringe upon the rights of people to make their own decisions regarding what kind of plan they want to be in, or if they want to be in a plan, what kind of health care they want, what kind of doctor they want, whether they want alternative care, whatever," he said.

Emphasis in the above quote is my own.

While I am a fiercely independent individual myself, I have a feeling that enacting universal health care, or at least universal coverage, may well end up requiring mandates in order to ensure that everyone participates. The story above is one that should make everyone consider their exact feelings on the subjects of autonomy, choice, and universal care.

SOURCE: "N.J. 'doing something about' universal health care with law, Corzine says" 07/09/08
SOURCE: "Controversial measure aims to prevent universal health care" 07/08/08
photo courtesy of Alejandro the Great, used under its Creative Commons license

Ill Will In DC

The DC Council has aimed its sights at providers of care and housing for the developmentally disabled in our nation's capitol. It would seem that continuing reports of substandard care, coupled with research into the salaries of the providers' top executives have reached the confrontational level.

Daniel De Luc at The Washington Post reports:

During a hearing, council members Tommy Wells (D-Ward 6) and David A. Catania (I-At Large) said they were tired of hearing rounds of excuses from the providers of group housing for the approximately 1,200 mentally disabled persons in the District's care. It was the first major council hearing on the developmentally disabled since Mayor Adrian M. Fenty (D) took office last year and marked a new, intensive scrutiny from the council.

"You either have to come up with a strategy to [improve] or get out of business, because you cannot provide substandard care," Wells told several of the providers who appeared at the hearing.

The District has an embattled history when it comes to this particular topic. Three decades ago the District was sued over the poor quality of care offered. Last year a federal judge found that the city officials had failed the disabled residents in question. Then this last May, a court monitor reported that these residents "remain at very serious risk." This history provides the foundation of the Council's dissatisfaction with private and non profit providers, but what really seems to have touched off the powder keg is the revelation of key executive salaries in the companies involved.

Wells and Catania, whose staffs researched tax records, noted that top executives at some providers earn more than $200,000 a year and singled out David Wilmot, president of Individual Development, which operates 11 group homes in wards 7 and 8.

Wilmot, a well-known D.C. lawyer who has been active in politics, is paid $300,000 annually, the council members said. And they noted that Wilmot and another board member had received loans from the company.

"I think that's hard to justify, considering where we're at," Wells said, calling it "extraordinary compensation."

The Post article provides some solid background as well as details of the arguments used by Wilmot and others to justify their salaries in light of the situation. The fur will be flying, I predict, between the providers' justifiable arguments of unqualified workforce and low reimbursement rates to the recent relocation of over 160 patients when their providers moved out of the "low reimbursement zone."

This is guaranteed to be a hot topic as it develops. Valid and worrisome issues that directly effect both patients and providers will be the centerpiece as the drama unfolds.

SOURCE: "City Council Members Criticize Providers" 07/08/08
photo courtesy of eschipul, used under its Creative Commons license

The $40 Million Push

What do Elizabeth Edwards, ACORN, AFSCME, Americans United for Change, Campaign for America's Future, Center for American Progress Action Fund, Center for Community Change, MoveOn, NEA, National Women's Law Center, Planned Parenthood, SEIU, UFCW, and USAction have in common?

They are all pulling together as a unified force in an attempt to storm the airwaves with a message of reform.

On July 8, Health Care for America Now! launched their $40 million campaign with a press conference for the National Press Club in which they unveiled their campaign plans as well as their first $1.5 million ad buy to support it.

Julie Bosman who writes for The New York Times' blog, The Caucus, brings us the money quote when it comes to the overall thrust of the ads:

Its theme? “You can’t trust the insurance industry to fix the health care mess,” said the spokeswoman, Jacki Schechner. “We’re educating the public about our principles and what we’d like to see from the president and the new Congress.”

For those of you who remember the Harry and Louise commercials that were a driving force behind the failure of the Clinton Administration's attempts at health care reform, this should be redolent of a certain "turnabout is fair play" ethos.

Ms. Bosman's post to The Caucus gives a good overview of the group and its aims. Roger Hickey, Co-Director of the Campaign for America’s Future, a founder of Americans United to Protect Social Security, one who helped to create and build Change America Now and the new Americans Against Escalation in Iraq, shares his perspective as a man on the inside of the efforts in this piece on the Huffington Post.

The battle for reform continues. Please feel free to drop us a comment on the ads if you see them aired in your area.

SOURCE: "New Health Reform Group to Spend $40 Million" 07/03/08
photo courtesy of Simon Davison, used under its Creative Commons license

Examining McCain's Proposed Health Care Tax Credits

Jonathan Cohn has a very interesting article up on CBS News. In it, he examines a recently released paper from the Center for American Progress which dissects Sen. McCain's proposed tax credits -- tax credits that are supposed to fix our broken health care system.

Under our current system, group health premiums (e.g., insurance you get through your job) are exempt from both income tax and payroll tax. Sen. McCain has suggested doing away with that exemption and replacing it with a tax credit ($2,500 for individuals, $5,000 for families) tied to the purchase of individual insurance.

Via Mr. Cohn's article:

McCain's advisers say that the credit would grow at the rate of inflation -- that is, it'd get more expensive at approximately the rate of other goods (or, at least, how the government measures the price increases of other goods). Health care expenses, of course, keep going up faster than other expenses, mostly because of medical technology and the (largely unrestrained) demand for it. So if people kept paying for the same level of insurance, the tax credit would quickly fall behind: They'd end up paying more in taxes. According to the report, "In 2009, the credit will cover 36 percent of an average employer-provided family policy (based upon CBO projections). By 2018, however, the credit will cover only 24 percent of the cost of the same policy."

(This is all in addition to the fact that, for many families, the credit will not be enough to buy a policy — even now — because health care for families costs a lot more than $5,000 a year.)

Now, to its proponents, this feature of the tax credit — the fact that it increases so slowly — is a feature, not a bug. It's designed to encourage people to be more thrifty in their purchase of insurance. Ideally, they'll go for less generous policies — ones that don't subsidize so much wasteful care.

Mr. Cohn points out the crude nature of this approach to cost control, noting that it puts the entire weight of the problem on the backs of consumers while providing no guarantee that adequate health care will be forthcoming. No guarantee of available coverage, much less for pre-existing conditions. No limits on the amount of cost out-of-pocket for consumers.

One reason I enjoy Mr. Cohn's work is that he does embrace transparency in his writing. In the beginning of the article he notes that he has not yet had the opportunity to vet the report in full and that these are initial conclusions only. He closes with a reminder:

OK, and now to that caveat I promised at the beginning. Unlike Barack Obama, McCain hasn't been clear about exactly how he proposes to change the tax treatment of health insurance. And there are rumors around that they might not get rid of the existing deduction entirely, preserving it at least for payroll taxes. It's not clear how that'd affect the paper's conclusions, since the paper assumes the entire deduction goes away. But, of course, if McCain keeps some of the existing tax break, then either his plan won't have as dramatic effect period — or it will run up a higher deficit.

All in all, well worth reading, if for no other reason than to remind yourself that in the convoluted discourse on American health care it pays to dig below the surface on all claims and proposals.

SOURCE: "McCain’s Fuzzy-Math Health Care Plan" 07/05/08
photo courtesy of SoggyDan, used under its Creative Commons license

Text For Health, A New Twist on Tech

Technology comes up frequently when you live in the Information Age. On this blog, it rears its head quite frequently as we keep tabs on electronic medical records and online health care tools. Today I will be talking about technology, but not of any kind discussed in my prior postings. You see, today I'm going to take a look at text messaging.

While doing some online research, I ran across an intriguing press release out of the Delaware area. It seems that some doctors are using text messages with excellent results.

People stay healthier when they show up in their doctors’ offices for necessary health check-ups, but it’s sometimes challenging to get them there. Today, one Medicaid program, Delaware Physicians Care, Inc. (DPCI), is using cell phone text messaging to remind members of appointments, let them know if they have missed an appointment and inform them when they should be scheduling tests or additional appointments.

This makes perfect sense to me now that I am aware of someone doing it. A few weeks ago, I was speaking with a friend from DePaul University in Chicago's computer department about online social networking, a pet area of study for both of us. He commented that the younger generation seems to have moved past email and have adopted text messages as their preferred communications mode. If that trend carries over, this could be a program with huge potential.

In the meantime, it has already had verifiable results according to the release:

In the 2006 pilot project with diabetes patients, DPCI found that after six months the percentage of patients receiving a necessary test rose from 52.3 percent to 70.5 percent in members receiving text messages. Furthermore, the results were much higher than the 45.4 percent rate for members of a control group of diabetes patients who did not receive text messages.

A nearly twenty percent increase is nothing to sneeze at. We are a culture that loves immediacy, and using text messages for health maintenance seems apropos. If nothing else, it is an attempt at thinking creatively as we seek solutions to the state of our health care system. Even if it proves not to be viable in the longterm, this still bodes well as a signal that people are actively seeking innovative solutions.

All I have to say is, "Go, Delaware!"

SOURCE: "Text Messaging—a New Way for Delaware Physicians Care to Help Its Members" 07/30/08
photo courtesy of Nesster, used under its Creative Commons license

The AMA on EMRs

Technology is a repeated refrain in the ongoing national health care dialog. The virtues are well known, especially to readers of this blog. Studies have been enacted by numerous foundations and organizations that show the massive savings of both money and time that electronic medical records (EMRs), properly implemented, can provide. By the same token, the discussion of EMRs also brings up a consistent set of issues that are of concern to medical providers: cost of implementation, privacy issues, and technical standards.

Thanks to the online edition of AMedNews, we can take a look at the American Medical Association's views prior to the hard copy's release date of July 7, 2008, addressing this triple header of concerns.

On standards:

As work continues to develop a national strategic plan for health IT, including any coordination of the multiple government initiatives already under way, it is essential that doctors have a strong voice. It is physicians, after all, who will be expected to invest heavily in making the system work.

The AMA also stresses that physicians with small practices should be given a voice in this discussion since they comprise the majority of medical practices in the United States. This push for standards, compatibility and systems thinking is one that is at the core of George C. Halvorson's approach. Involving the actual physicians in the crafting of these standards is extremely important. After all, they will, as pointed out above, be footing the bill.

On privacy:

To boost confidence in an integrated network, the Health Insurance Portability and Accountability Act's privacy and security rules that apply to physicians, as well as other health care professionals and health plans, should be extended to any party that works with confidential health care records. This would include workers' compensation carriers, researchers, life insurance issuers, employers, marketing firms, health IT and personal health record vendors, and health information exchanges.

Doctors, says the AMA, do not need to see an expansion of their HIPAA obligations. The organization states that this would slow down transmission of patient data as new restrictions are implemented. Instead, their proposal hinges upon expanding the privacy strictures of HIPAA to apply to anyone handling this confidential data.

On implementation:

Physician reimbursements already are under intense pressure, and the Congressional Budget Office itself has released a report doubting estimates of extraordinary, health IT-related savings. It's no surprise that many practices, especially small ones, find it justifiable to avoid health IT investment. Meaningful grants, loans and other financial incentives are essential for giving physicians the financial security they need to accept and accrue the benefits of health IT.

With the cost of implementing EMRs quoted at $37, 000 per practicing physician (and that is a starting number that does nothing but increase), these sort of incentives seems to be in order. It would be a nice change from the perverse incentive standards of the modern day medical profession.

The article goes on to relate the AMA's position as it attempts to influence the U.S. Congress, which even now is deliberating the proper ways to push expansion and implementation of health information technology. Go take a look and see for yourself what your opinion is of their stance.

SOURCE: "Removing health IT barriers: The AMA advocates that federal legislation to encourage technology use should incorporate physicians' ideas, particularly in regard to technical standards, privacy and financing." 07/07/08
photo courtesy of Daquella manera, used under its Creative Commons License

21st Century Dynamic Duo: Bankruptcy and Health Care

Since my wife's family is mostly in the Indiana area, I tend to check out the news up there fairly frequently, especially with the recent levee failures and flooding. That is how I stumbled upon this letter to the editor by Fran Quigly, Director of Operations for the Indiana-Kenya Partnership, on IndyStar.com. The introductory paragraphs should be enough to get you started:

It is Friday morning at the federal courthouse in Downtown Indianapolis, and U.S. Bankruptcy Court Trustee Gregory Silver sits behind a low table in a room on the fourth floor calling out names of Hoosiers who have filed for discharge of their debts. In a somber scene with the air of a fiscal confessional booth, many petitioners come forward with slumped shoulders and slightly bowed heads, and then softly answer Silver's questions about the financial collapses that led them to this room.

A young woman from Southside Indianapolis has racked up enormous debt due to the costs of childbirth. A middle-aged couple from the Northwestside was sued for payment of their medical bills. Another woman had the misfortune of being attacked by a dog before health insurance from her new job kicked in. Even after turning a lawsuit settlement over to bill collectors for hospitals and doctors, she still owes them $35,000.

The rest of the letter is well worth reading, and if you have strong stomach the comments are interesting as well. I think the comment streams one finds on articles like this make for an interesting study, most particularly the anonymous comments. People tend to speak their minds pretty staunchly when they do have to worry about being connected to their opinions publicly.The results can often be both vile and illuminating.

On a subject that combines high profile and controversy in the fashion that health care currently does the comments come thick and fast, a maelstrom of invective and opinion that demonstrate just how impassioned our populace is becoming on the subject.

The letter goes on to suggest potential paths for improvement, and quotes a 2005 Harvard study that found fifty percent of bankruptcies in the U.S. stem from medical bills.

Fifty percent. Think about it.

SOURCE: "A day in bankruptcy court would make you sick" 06/30/08
photo courtesy of danesparza used under its Creative Commons license