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New Yorker 6-28-12: Atul Gawande: Why the Uninsured Are Still Vulnerable — The debate rages on
Below is an excerpt from Atul Gawande’s op-ed piece that was published in The New Yorker after the Supreme Court upheld the Affordable Care Act last June. The debate rages on during the presidential campaign.
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During the nineteenth century, for instance, most American leaders believed in a right to vote—but not in extending it to women and black people. Likewise, most American leaders, regardless of their politics, believe that people’s health-care needs should be met; they’ve sought to insure that soldiers, the elderly, the disabled, and children, not to mention themselves, have access to good care. But many draw their circle of concern narrowly; they continue to resist the idea that people without adequate insurance are anything like these deserving others.
And so the fate of the uninsured remains embattled—vulnerable, in particular, to the maneuvering for political control. The partisan desire to deny the President success remains powerful. Many levers of obstruction remain; many hands will be reaching for them.
For all that, the Court’s ruling keeps alive the prospect that our society will expand its circle of moral concern to include the millions who now lack insurance. Beneath the intricacies of the Affordable Care Act lies a simple truth. We are all born frail and mortal—and, in the course of our lives, we all need health care. Americans are on our way to recognizing this. If we actually do—now, that would be wicked.
See on www.newyorker.com
Poking Fun at My Patients to create an environment that feels at least a little normal
“I joke around with my patients to create an environment that feels at least a little normal in the craziness of their disease, so they can focus on living, not dying.”
Certain aspects of medical school, like learning the basics of normal and abnormal organ function, or rotating onto specialty services as mini-apprenticeships to recognize disease and treat it, haven’t changed much in 100 years of medical education.
What has changed is the emphasis on communicating with patients, which includes understanding how social and cultural factors and life circumstances can influence everything from disease occurrence to medication compliance. This is a good thing.
Leukemia doesn’t read a person’s tax returns, and my patients run the gamut. In the same morning recently, I saw a Russian oligarch who comes for visits in his private jet and a 20-year-old whose leukemia diagnosis kept him from serving jail time, and who catches the Regional Transit Authority bus for his appointments. I need to have insight into their lives outside my stark exam room to appreciate how their environments will affect the care plans we develop.
We also learn how patients react to illness, and how a diagnosis like cancer can dramatically alter a family’s landscape, or how a person defines herself.
See on well.blogs.nytimes.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
SGR Repeal Plea Backed by 110 Physician Groups
Here we go again:
More than 110 physician specialty and state medical society organizations this week renewed what has become an annual plea for Congress to repeal the sustainable growth rate formula.
If implemented according to schedule, the SGR will cut doctors’ Medicare pay 27%, leaving doctors with only 73 cents of every dollar the program pays them today starting on January 1, 2013.
The cost of repealing the SGR to restore those payments would be $245 billion over the next 10 years, according to August projections from the Congressional Budget Office.
See on www.healthleadersmedia.com
Modern Physician: Practice Makes Perfect: Preparing for shared-risk reimbursement models
In June, the MGMA-ACMPE released the results of a questionnaire that ranked members’ most-pressing practice management challenges. In this edition of “Practice Makes Perfect,” we’ll tackle No. 2 on that list: Preparing for reimbursement models that place a greater share of financial risk on the practice.
One of the many hot topics at our upcoming annual conference in San Antonio will be the changing healthcare environment and how practices can—and should—prepare for new payment methodologies. The federal government and commercial insurance companies are in the midst of changing the way they pay hospitals and doctors. Some of these changes are the result of the Patient Protection and Affordable Care Act as well as market forces. These changes will affect practices in all settings, and it’s important to prepare for reimbursement models that place a greater share of financial risk on the practice.
Physicians may soon be at financial risk as payers test and adopt new payment methods. The CMS and private insurers are proposing models to replace separate payments to hospitals, doctors and other providers with a single bundled payment, and we are seeing multiple definitions of bundling. A common type of bundled payment involves a single payment for all services furnished before, during and after a hospitalization, including outpatient diagnostic tests, inpatient facility costs, drugs, supplies and the professional services of every physician involved in the patient’s care.
In addition, the CMS and many insurers are testing variations on the capitation payment concept that was widely used in the health maintenance organization craze of the 1990s. Commonly referred to as “global payment,” this reimbursement method pays a set amount per patient (usually adjusted by demographics) and the provider accepts responsibility for a predetermined set of services regardless of the costs.
Both bundled and global payment reflects a sea change from the traditional fee-for-service payment system. Payers hope that bundled and global payments will create incentives for primary-care physicians, specialists and hospitals to better coordinate services and share accountability for the cost and quality of services. They hope the new payment systems will improve the care their beneficiaries receive while lowering the total cost of care by eliminating redundant services.
These new payment methods require doctors to think in new ways and will challenge the information systems of even the most sophisticated fee-for-service practice. Bundled and global payments change a practice’s profit calculation from emphasizing service volume to operating efficiency.
In this new payment environment, practices that gather the right information and provide high-quality, lower-cost care will be the most profitable.
See on home.modernphysician.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Medical Homes Survey: Primary care with a personal touch – Modern Healthcare
Medical Homes Survey reveals diverse settings, but single goal: Increase quality of care.
When primary-care physicians needed to go somewhere new to revitalize their field, they found that there was no place quite like the patient-centered medical home: A practice model that emphasizes care coordination, increased access and enhanced doctor-patient communication—all with an emphasis on continuous quality improvement.
Modern Healthcare’s second annual Medical Homes Survey, conducted June 25-Sept. 28, drew responses from 29 organizations. The survey sample illustrates the wide variety of settings among the 4,870 sites that have been recognized as medical homes. One survey response came from an organization with a staff of 350 doctors, and another came from a solo practice. The largest group in the survey has an enrolled patient population of 939,000 while the smallest has 823. One thing they have in common is a desire to increase the quality of care by advancing an old-fashioned concept that is often enhanced by the newest technology.
See on home.modernhealthcare.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Modern Physician: Lovelace Health acquires physician practice
Albuquerque-based Lovelace Health System has acquired Southwest Medical Associates, a physician practice that will retain its name, leadership and all 150 employees in the deal. No financial terms were disclosed, said a spokeswoman for Lovelace.
Effective immediately, the transaction starts a new physician model for Lovelace that will rely on a mix of employed, strategically aligned and community physicians.
See on home.modernphysician.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Physician Associates to be bought by Orlando Health – Orlando Business Journal
According to the Orlando Business Journal: Physician Associates LLC has agreed to negotiate exclusively to be acquired by Orlando Health.
The details of the arrangement, including dollar value, have not been disclosed, but analysts spoken to for a story in August speculated the deal could be valued anywhere from $20 million to $60 million.
“Physician Associates LLC and Orlando Health today announced the physician practice has selected Orlando Health as the organization with which it will begin exclusive acquisition negotiations,” said Kena Lewis, Orlando Health spokeswoman.
Florida Hospital also was vying to buy the practice.
See on www.bizjournals.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Park Nicollet’s experiment with ACOs – TwinCities.com
In 2005, Park Nicollet Health Services started participating in a pilot project that was the first to test the idea of “accountable care organizations” in the federal Medicare program.
Called the Physician Group Practice Demonstration Program, Park Nicollet was one of 10 large multi-specialty groups across the country that agreed to adopt a new payment relationship from Medicare for a portion of its patients.
The premise was straightforward: If Park Nicollet and other groups could provide care at a lower cost while meeting quality standards for patients, the groups would share the savings with Medicare.
But as a study published this month in the Journal of the American Medical Association shows, results from the Physician Group Practice, or PGP, project have been mixed. Overall, researchers found that the five-year pilot delivered only modest savings, although savings were larger for a subset of patients, many of whom have complex health problems.
“(Park Nicollet) received a bonus payment in only one year of the PGP,” said Carrie Colla, a researcher with the Dartmouth Institute for Health Policy and Clinical Practice. “But in the (subset), they saved quite a bit of money.”
Improving care while lowering costs for complex patients is one of the key challenges facing the nation’s health care system, said Dr. David Abelson, the chief executive officer at St. Louis Park-based Park Nicollet, during an August 2011 interview about the pilot project.
See on www.twincities.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
From HMOs to ACOs: Meet the newest model in health care management – TwinCities.com
When critics look at health care in America, many describe a system that’s fragmented, inefficient and burdened with waste.
Doctors and hospitals generally are paid a fee for every service they provide, the critique goes, so they lack financial incentives to effectively coordinate care and make sure patients get only the services they need.
Patients often have a front-row seat on the dysfunction, critics say, as they are shuffled off to specialists without needed paperwork, undergo unnecessary tests or make repeat hospital visits when medical centers don’t get it right the first time.
Enter “accountable care organizations,” a new structure in health management that the federal government, health insurers and some physicians hope will tame the woes. Doctors, hospitals and clinics would be given responsibility to provide care for a group of patients — within a budget. If health care providers better coordinate care to provide good quality for less money, they can share in the savings.
Republicans and Democrats “agree that transitioning from fee for service to global payments in health care will be necessary in order to deal with the budget deficit,” Bottles wrote in an email. “The consolidation of the health care industry will continue no matter which party prevails in the November election.”
This push for accountable care organizations (or “ACOs”) is driving a consolidation trend among health care companies that’s increasingly being felt in Minnesota. The clearest example is a plan announced in August to combine the HealthPartners and Park Nicollet health systems into one of Minnesota’s largest nonprofit health companies, with 20,000 employees, including 1,500 physicians.
See on www.twincities.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Estimating a Reasonable Patient Panel Size for Primary Care Physicians With Team-Based Task Delegation
Annals of Family Medicine — Sept/Oct 2012 Issue:
Conclusions: If portions of preventive and chronic care services are delegated to nonphysician team members, primary care practices can provide recommended preventive and chronic care with panel sizes that are achievable with the available primary care workforce.
Discussion: Solving the primary care dilemma—excessive panel sizes in an environment of a primary care physician shortage—requires the replacement of physician-only care with team-based care. Such an unprecedented change in both the culture and structure of primary care practice can be accomplished only through a change in clinician mindset, the training of nonclinician team members, the mapping of workflows and tasks, the creation of standing orders that empower nonclinicians to share the care, the education of patients about team-based care, and the reform of primary care payment. Fortunately, all these elements are being implemented in many innovative primary care practices around the United States. These practices point to a future of high-functioning primary care teams that can ensure health care access and quality for the nation’s population with a reasonable work life for physicians and other team members.
See on www.annfammed.org
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Joseph Rugg's Health Law Blog 