Thursday, January 22, 2009

The Post Inaugural Health Wonk Review Celebration Event

There is something very unique about the United States’ mix of unabashed patriotism and Hollywood showmanship during times of national celebration. Sure, other countries can assemble their own organized spectacles, but there is something exceptional about all those flags, speeches, music, salutes, color guards, banners, close ups on children’s faces, tributes to heroes past and present as well as the earnest rhetoric that makes the hardest cynic proud to be an American.

What better example of this phenomenon than the star studded We Are One pre-inaugural concert, complete with its own Washington D.C memorial building with an A-list cast of cinematic liberal luminaries and mega-rock stars? Sure, the entertainers may not know all that much about the ins and outs of our new President’s policies and yes, the music’s lyrics had nothing to with foreign affairs, health care or the federal budget, but their hearts were in the right place. It was a heluva show, even if you had to watch it on a jumbotron.

Since this is a grand participatory democracy and the Disease Management Care Blog believes no part of our nation’s body politic should be immune from having a chance to celebrate, it decided that we wonks and readers could have our own concert. ‘What?!’ you say? No stage, no sound system, no Hollywood types, no rock stars? ‘No problem’ says the DMCB. This is a virtual world, the web is our stage and the music is only a click away. And we have speeches aplenty. The DMCB knows because it has screened them all.

Ladies and gentlemen, welcome to the Post Inaugural Wonk Celebration Event, brought to you by the best and the brightest thinking of some very smart health policy blog writers. Read, learn, listen to some tunes (assuming you have speakers) and enjoy while we wish President Obama the best in his coming administration.

Taking the stage first is New Health Dialogue Blog’s Joanne Kenen, who examines a recent MedPAC recommendation that hospice care be ‘front loaded’ with higher payments at the start of the care and then “back filled” with higher payments when the end comes. MedPAC knows that when you cover a service that offers better care for a higher payment that is welcomed by hospitals, physicians, families and patients, gaming is as inevitable as death and taxes. And look, the band taking the stage is Aerosmith, singing take me to The Other Side.

Oh double look, here comes Brady Augustine of the MedicaidFrontPage blog, who has a three-fer. He looks at the status of SCHIP renewal and extension and the implications of failing to secure Republican support for the inclusion of immigrants as well as the lack of available funding at the State level. Then he reviews the recent report in the New England Journal of Medicine that operating room check-lists save lives. Most of all, DMCB likes his explanation of the curious logic behind Florida’s nursing homes’ willingness to support a tax increase to secure more Federal matching funds. Complex? Yes. Creative? Yes. Is this the kind of dysfunctional funding that distracts us from creating high performing care systems? Yes. The very opaqueness of public funding is not unlike the lyrics from Brimful of Asha by Cornershop. The DMCB doesn’t understand these words to this song either, but doesn’t care because it thinks a camera is focusing on him and the spouse while they are grooving.

For further insight about SCHIP, listen to Anthony Wright of the Health Access Blog. He points out that the Democrats not only have the Republicans to deal with, but also their more leftward leaning colleagues who are demanding a lower threshold for access of immigrant children to SCHIP. Drawing on the lessons from California’s star-crossed run at expanding access to health insurance, he notes the pursuit of bipartisanship in the defense of health care is no virtue – it’s a delay. Which is why Dierks Bently bemoans his inability to keep the Republicans and Democrats from splintering by singin’ Trying to Stop Your Leaving.

And here comes Maggie Mahar of the Health Beat Blog on the same topic of SCHIP. Yes, she says, partisanship is a messy time consuming feature of the formulation of policy, but that’s because partisanship is another word for a willingness to debate and act on social values. Ditto the role of ideology in evidence-based medicine, which she argues should be implemented using a set of beliefs. Is this a necessary evil or a vital part of our democracy? Check out Maggie’s twin posts here and here on the matter and decide for yourself. Katy Pery can’t decide, so she’s decided to croon Hot N Cold for the crowd.

The DMCB and the crowd are big fans of nurses. Overworked, underpaid, these healthcare foot soldiers probably know more than anyone about what’s good and what’s bad about the system. Which is why Annie of the Virtuous Skeptic’s recounting of the American Nurse’s Association’s Social Policy Statement would be welcome in any venue. Read and learn more than you’d otherwise hope to learn about his noble profession. Yes, they’re Unglamorous sings Lori McKenna, but they rock!

Think our neighbors to the north are convinced that their healthcare system is all that it should be? Sam Solomon is now up and points out in Canadian Medicine that that may not be the case. The physicians are debating the merits of a public vs. more private approach and it’s being played out in a contentious Canadian Medical Association election between family practitioner Dr. Tracey, who leans toward greater privatization of the system, and Dr. Turnbull who supports a publicly funded system. Read their ‘vote for me’ statements and find out that even with the dominance of public funding, there are eerily similar debates over administrative work, access, payment levels, evidence based medicine, the role of market forces and electronic records. Along with us, our Canadian friends are struggling to find a Better Way. Ben Harper is now up singing about it.

While we’re on the topic of Canada (hey, if an Irish band can rock the pre-inaugural concert, international stuff is fair game) check out The Lucidicus Project’s Jared Rhoads’ assertion that Canada is really all about pseudoscientific global budgeting that really relies on patient queues and the questionable substitution of cheaper services to make up the difference when the yearly allotment runs short. The DMCB has heard this argument over and over but some Canadians apparently believe it. Why else would they Drive South asks John Hiatt?

It’s David Williams of the Health Business Blog’s turn and he’s here to discuss the Ingenix settlement. As the DMCB understands it, Ingenix was a business hatched by the managed care industry that in turn sold information about prevailing fee schedules to the managed care industry. The allegation from the New York Attorney General is that it artificially lowered the published fee schedules so that insurers could pay less when their patients went out of network. While many reports would have you believe that the AG helped the little guy here, this contrarian post by David points out that many fee schedules are inflated, opaque and highly variable. He doesn’t think the terms of the settlement is all that. This reminds the DMCB of just another chapter in the financial arms race between insurers and providers. Figuring out how to understand just how insurers pay providers? Donovan from this black and white vintage link tells the jumbotron viewers that we might as well try to Catch the Wind .

Not satisfied and want to hear even more about claims payments? Then pay attention to this other post from the Health Access Blog. In a fit of unusual clarity, the California Supreme Court has ruled that individual patients should not be put into the middle of a payment dispute between a big institutional hospital emergency room and a big institutional insurer HMO over the adequacy of payment for treatment. If the ER feels they are not being paid enough, the California Supremes say there are plenty of mechanisms that allow them to appeal. Emergency rooms balance billing patients? Outrageous sings Paul Simon. The crowd loves it.

But wait, there’s more on the Ingenix matter. Richard Eskow of The Sentinel Effect is telling the revelers about the Ingenix settlement from the perspective of someone who personally got stiffed to the tune of an extra thousand bucks – and he’s an industry insider. While he thinks the terms of the settlement are good, he has his doubts about its overall impact because consumers still won’t understand the pricing, won’t be able to negotiate the charges or avoid being billed for extraneous services. Beware, he says, the settlement is only a piece of the puzzle: it won’t have a big effect. Del Amitri agrees and is now singing that patients are always the Last to Know.

Henry Stern of InsureBlog helps the concert-goers be among the first to know about a study on Consumer Driven Health Plans released by UnitedHealthCare. They found there were considerable savings and that the bulk of them come from changes in health care utilization, not cost shifting. The DMCB wants to learn more but, along with the rest of the crowd, needs to move onto the next act. You can find the post and the link to this report by clicking here. You can hear Joe Walsh sing about this Happy Way of insuring folks by clicking here.

Joe Paduda of Managed Care Matters entertains by donning the swami hat and helps our virtual concert-goers prepare for What Is Coming for Health Plans. The ‘shun’ keywords are consolidation (and he names names), their response to coming legislation (a mix), regulation, physician collaboration (‘Why can’t we be friends?’), expansion of Medicaid, contraction (thanks to loss of jobs and fewer member months) and stagnation. Find out the details while Patty Griffin commiserates with the health plan audience members out there by singing We Don’t Need No Bad News.

Nancy Miller of ultrasound technician schools blog frets that open computer terminals laying about hospitals are making it too easy for n’er do wells and evil doers to blow past the nominal HIPAA safeguards and steal your identity. It must change, she is telling the crowd – hospitals are obliged to take appropriate action. And here comes Green Day, emphasizing her worries by singing Warning.

Tom Wilson and Vince Kuraitis of the e-CareManagementblog give the throng eight takeaways from the Medicare Health Support on how to build better bridges toward better population health care. This is a must read if you want to know where the disease management industry is going. While you’re at it, you can enjoy his updated picture. And now up, appropriately enough, are the Pretenders telling the disease management vendors to Stop Your Sobbing.

Few people on the Mall would agree that’s there’s nothing necessarily wrong with making some money, unless of course, you are a for-profit health insurer and have a reputation for sticking it consumers. Not so fast, says forenamed Louise of the Colorado Health Insurance Insider, who went insurance shopping and found the premium amounts for a comparable policy from for-profit and not-for-profit insurers were pretty much the same out in her section of the country. Since the health insurance market is driven by price, price and price, concert goers would think that the non-profits would be able to use their favorable tax status and lack of any need to pay shareholders to reward consumers with lower costs. Not so, and that’s why the Mavericks are on stage singing Crying Shame.

Speaking of making money at a company level, how about making money at an individual level? Roy Poses of the Health Care Renewal Blog discusses one allegedly underhanded way of doing it in this post about a $1 Million CEO. Is this greed? Is this failure of Board governance? Conflicts of interest? Just another sad example of how disjointed things have become when it comes to performance vs. compensation? Roy has his opinion and this is your chance to develop one on your own. Whatever we do, however, the most important thing is that we don’t Shut Your Eyes to the matter. That’s what Snow Patrol is singing.

The DMCB suspects there are some partiers on the mall. Alas, allowing alcohol and drug abuse to wreck your personal and professional life is a terrible waste and a huge toll for our nation’s health care system. A standard approach is to refer such persons for counseling and treatment. But does it really work? That is the question raised to the crowd by Glenn Laffel of Pizaazz. This is not an insignificant issue. In these days of evidence-based healthcare, Glenn asks about that evidence and furthermore, points out that without it, it’s difficult to credential drug and alcohol rehab programs. MGMT asks if this means it’s Time to Pretend that we really know what we’re doing.

Think those wall sized jumbotrons are technology writ large? Well, healthcare is also moving so fast that its disruptive technology is being disrupted by the disruptiveness of even newer technology. Case in point brought to the audience thanks to David Harlow of the HealthBlawg: American Well, which consists of a virtual online and telephone consultation service with access to a wide range of physicians that are available for 10 minute appointments that cost about $10 (a co-pay with insurance) to $45 (no insurance). Madonna agrees about the pace of change while she sings Ray of Light.

Michael Cannon of CatoAtLibertyBlog takes on the prospect of the Obama administration pulling the rug out from under the ENTIRE 9 million member strong Medicare Advantage Program. Michael reminds listeners that this contrasts conspicuously with candidate Obama’s promise to maintain choice when it comes to insurance options. He thought that Plan A of those darn liberals was to starve Medicare Advantage by slowly reducing payments but this frontal assault via outright cancellation could mean the end of a huge batch of innovation, cost savings, quality improvements, provider incentives and care coordination in a successful part of the Federal insurance program. Has the Obama Administration already Missed the Boat? Modest Mouse sings about it.

Robert Aurbach of Workers’ Comp Insider is next up and looks at how workman’s compensation payments that have already been arranged for injured workers can be held hostage by Chapter 11 bankruptcies. Patients are ill prepared when their payments suddenly stop, are unequipped to deal with the cross-state legal issues and are being shortchanged by underfunded so-called guaranty funds he warns. Even Joe the Plumber, for all his bombast, could be left holding the bag as a ‘least worthy creditor,’ not a human being who was counting on that monthly check to make ends meet. And even though Ted Nugent would probably rather sing for Michael Cannon, he rocks on over this by calling it an unnecessary Stranglehold.

And here’s a new term to reward you for attending this concert all the way to the end! Neil Versel of the Healthcare IT Blog finds that the definition of ‘academic bulimia’ has reached enough of a critical mass to be applicable to the error-dense environment of the teaching hospitals that don’t have adequate information technology (IT) decision support. Wake up hospital administrators, he says: When it comes to IT support, the choice should be Easy. The Barenaked Ladies are on stage saying so.


Anonymous said...

Happy Post-Inauguration Day! Wonderfully rich edition of the carnival! Thank you for including my submission.

H G Stern said...

Jaan - That's just TOO cool!

Excellent HWR; thanks for hosting, and for including our post.

Anonymous said...

Fun! I do believe this is our first rock concert edition. Very creative, Jaan!

Vince Kuraitis said...


Anonymous said...

Brilliant. Best HWR ever.

Anonymous said...

Thanks, Jaan
Great script and great soundtrack!

Anonymous said...

You can't see me, but I'm holding up my lighter . . .

Laura Brasnan said...

Way to go... so much ground covered in on little post!
mind blowing...