Archive for October, 2013

Ohio Decides to Expand Medicaid

October 27, 2013 Leave a comment

As reported in “Action of Ohio Controlling Board on Medicaid Expansion” posted on Bill of Health, a blog sponsored by the Petrie-Flom Center at Harvard Law School:

On Monday, October 22, at the urging of Governor Kasich, the  Controlling Board of the Ohio Legislature voted 5-2 to accept $2.5  billion in federal funding to expand Medicaid in the State of Ohio.  Under the laws of Ohio this action was valid.



Illuminating an illness without end: Fellows Friday with Jennifer Brea

October 27, 2013 1 comment

Could someone without healthcare insurance and only showing up at an ER, looking for charity care, ever have been diagnosed or treated appropriately?

The Need for Physician Leadership Development

October 27, 2013 Leave a comment

It is critical now that medical practices take the steps needed “to retain, develop, and align [its] medical staff to meet the challenges of a fast-changing and highly competitive healthcare landscape.”  Good physician leaders can help achieve those goals.  This is the message in a recent post from Physicians Practice, “Medical Practices Must Focus on Physician Leadership Development.”

Equally important, however, is the need for physician leaders to see and develop opportunities as a result of forces in the very fast moving healthcare environment outside of their own medical practices.

Questions, like the following, are constantly swirling around medical practices, and I fear they are as often ignored as they are avoided:

  • Should we align with the hospital?
  • Should we join a large physician group?
  • Should we develop our own super group?
  • Should we join the hospital sponsored clinically integrated network?
  • Should we start our own network?

Hospitals and venture capitalists have the money, the time, and the leadership to develop and pursue healthcare business opportunities, and they are doing so. They are taking the lead in presenting answers to these questions. Physicians are at a disadvantage, because they rarely have the money or the time or, unfortunately, the leadership to be proactive in evaluating and accepting or rejecting opportunities as they present themselves.

If survival as independent practices is the goal, then in this highly competitive business environment, physician leadership has never been more important.  This has been the message of many physician practice commentators, including Kevin Pho, M.D. on his blog, as well as physician leadership training programs like the one done at the University of Cincinnati.

No one is waiting for physicians to step.  When they do, they can control their professional destiny. When they don’t or can’t, others will be in control.

Sore from being Kicked

October 26, 2013 Leave a comment

Republicans make a lot of hay pointing out how health insurance premiums available on the health insurance exchanges have increased for many Americans.  Where this is true (and is not true in all states), it is the result of many factors.  Some of the increase is the result of more benefits being provided as required by Obamacare, some of the increase is the result of the prohibition against denying coverage because of pre-existing conditions and related protections under Obamacare, and much is the result of bad decisions (both historically and recently) by state legislatures or governors or both.  Some of these decisions were made for the sole purpose of hurting the implementation of Obamacare — e.g., refusing Medicaid expansion, not setting up a state exchange, not exercising authority over insurance rates, etc.

No one wants to pay more for the health insurance they already had.  Some increase may have been inevitable.  However, we should make sure to place much of the blame on short-sighted political shenanigans aimed at thwarting healthcare reform at the expense of people.  I have written before about Florida’s Governor Rick Scott and his campaign of lies and deceit against Obamacare which many Florida Cabinet officers and Department heads and State Legislators have endorsed. Apparently, Wisconsin’s Governor Scott Walker is just as bad — health insurance premiums for Wisconsin residents will be 79% to 99% higher than those for Minnesota residents because of him.

Yes, there have been some pretty horrendous computer network issues at the exchanges that have frustrated and dissappointed those seeking to get health insurance.

But can’t we all agree that there is a difference between the unintended (even negligent) computer snafus on the one hand and the deliberate behavior seeking to do harm on the other?  As Oliver Wendell Holmes, Jr. wrote in The Common Law, “Even a dog distinguishes between being stumbled over and being kicked.”  Frankly, I’m a little sore from being kicked.

What the Shutdown Revealed About the Economic Divides in U.S. Politics

October 19, 2013 Leave a comment

Tea Party America doesn’t look much like the base of the big-business Republican Party

This is a disturbing study of our fellow Americans.  There are all sorts of people on the edges of the bell curve of life.  While I have no love for the leaders of the Tea Party, whom I believe purposely and maliciously lie to their constituents and mislead them, the Americans who want smaller, less wasteful, and less intrusive government, are honest and sincere in their beliefs.  They are wrong, but that’s another discussion.  The study, on the other hand, in the vein of lies, damn lies, and statistics, paints them as less creative (and by implication less intelligent.

See on

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Avoid Being the Ostrich

October 19, 2013 Leave a comment

A recent post on the Deloitte Center for Health Solutions Blog, “Convergence in health care: The opportunity in uncertainty,” starts off with the following statement:

There is no question that significant change is occurring in the health care industry and nobody really knows exactly how all of this is going to play out over the next couple of years. In light of all of this uncertainty, one of two scenarios could have played out: players in the health care industry could have sat on the sidelines, waited it out to see what happens, and avoided the potential risk that comes with uncertainty. Instead, the alternative scenario is playing out with organizations across all parts of health care using change as an opportunity to make bold plays from a strategic perspective. Some of that is manifesting itself in consolidation within sectors, and some of that is manifesting itself in convergence across sectors.

I agree.

As I tell my healthcare clients, the roller coaster healthcare environment presents them with many alternative business opportunities.  However, one alternative that must be avoided is doing nothing.  Doing nothing is not the same as staying where you are.  The status quo may be the right strategy for some.  For others, it may be consolidation and convergence.  But everyone needs to stay focused and be an active participant in his or her business future.  Involvement is required to evaluate the different alternatives and make a good decision.  Otherwise, opportunities will be lost and maybe lost forever.

Fighting Lies and Ignorance to Keep the Democratic Process Democratic

October 13, 2013 Leave a comment

The health care crisis and how to solve it has become one of the defining issues of our time.  There is much debate over the right course of action.  The debate should be principled and intelligent, but we have come to a point in American politics where lying or being stupid or both have become a perfectly acceptable way to debate an issue.

If one assumes that Romney, Ryan, Rand Paul, Cruz, Rubio, Bachmann, Palin, Rick Scott, Pam Bondi, and many other outspoken opponents of Obamacare are intelligent people (an assumption that may be a stretch in some cases), then they must be liars. Other than their being ignorant beyond comprehension (which could be the case for some of the named individuals), lying is the only explanation for what they have been saying about Obamacare.

Honest, intelligent people make sure of their facts before making public statements about this complicated, important legislation.

An open and honest debate, where ideas are discussed and criticized and improved upon, is what is needed desperately in this country.  It is the way things are supposed to be done in America.

Americans of good intentions must be educated to fight the campaign of misinformation that has been waged against the President’s plan for health care reform.

Obamacare Facts is one place to get a detailed and unbiased description of what the law does and doesn’t do.  Go there, learn, so that, regardless of your position, you will know what’s true and what’s false and who is lying and who is telling the truth.  Perhaps, you can even help educate those whose ignorance is keeping them in the dark.

‘Navigator’ flaws compound new health care law’s glitchy start

October 13, 2013 Leave a comment

A program intended to help educate uninsured people in Western Pennsylvania about Obamacare started sluggishly because ‘navigators’ are not trained, and several positions remain vacant nearly two weeks after online insurance marketplaces went live.

Seriously, there is no way that a program this big trying to help so many people in the face of so many obstacles would not have start-up issues.  Making things better should be the focus, rather than the rants of the Tea Party Congressmen.

See on

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Poorest of the poor left out of Affordable Care Act’s health insurance expansion

October 13, 2013 Leave a comment

Because North Carolina rejected the Medicaid expansion earlier this year, the state’s poorest residents will go without insurance despite the national law that was intended to slash the number of uninsured.

This is another example of the short-sightedness (or just plain meanness — it’s hard to know which) of conservative state legislatures that decided taking a stand against Obamacare was more important than the health of its citizens.  The Presdient and the ACA will be blamed by the campaign of misinformation from the Tea Party, but this is their fault, not the President’s and certainly not the law’s.

See on

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How Health Care Reform is Supposed to be Working

October 11, 2013 1 comment

The RAND Corporation has published a study, “Effects of the Affordable Care Act on Consumer Health Care Spending and Risk of Catastrophic Health Costs.”

RAND provides the following summary of the study:

This study examines the likely effects of the Affordable Care Act (ACA) on average annual consumer health care spending and the risk of catastrophic medical costs for the United States overall and in two large states that have decided not to expand their Medicaid programs (Texas and Florida). The ACA will have varied impacts on individuals’ and families’ spending on health care, depending on income level and on estimated 2016 insurance status without the ACA. The authors find that average out-of-pocket spending is expected to decrease for all groups considered in the analysis, although decreases in out-of-pocket spending will be largest for those who would otherwise be uninsured. People who would otherwise be uninsured who transition to the individual market under the ACA will have higher total health care spending on average after implementation of the ACA because they will now incur the cost of health insurance premiums. The authors also find that risk of catastrophic health care spending will decrease for individuals of all income levels for the insurance transitions considered; decreases will be greatest for those at the lowest income levels. Case studies found that in Texas and Florida, Medicaid expansion would substantially reduce out-of-pocket and total health care spending for those with incomes below 100 percent of the federal poverty level, compared with a scenario in which the ACA is implemented without Medicaid expansion. Expansion would reduce the risk of high medical spending for those covered under Medicaid who would remain uninsured without expansion.

You can read the Study online or download a copy here.

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