10 October 2011

Basic Health Benefits for Millions to be Designed by Feds

Story first appeared on the Associated Press.
The federal government is taking on a crucial new role in the nation's health care, designing a basic benefits package for millions of privately insured Americans. A framework for the Obama administration was released Thursday.
The report by independent experts from the Institute of Medicine lays out guidelines for deciding what to include in the new "essential benefits package," how to keep it affordable for small businesses and taxpayers, and also scientifically up to date.
About 68 million Americans, many of them currently insured, ultimately would be affected by the new benefits package. That's bigger than the number of seniors enrolled in Medicare.
The advisers recommended that the package be built on mid-tier health plans currently offered by small employers, expanded to include certain services such as mental health, and squeezed into a real-world budget.
They did not spell out a list of services to cover, but they did recommend that the government require evidence of cost effectiveness.
In this day and age, when we are talking about fiscal responsibility, it's a report that recognized that we have to take account of what we can afford while trying to make sure that people have adequate coverage.
Until now, designing benefits has been the job of insurers, employers and state officials. But the new health care law requires insurance companies to provide at least the federally approved package if they want to sell to small businesses, families and individuals through new state markets set to open in 2014.
Most existing workplace plans won't be required to adopt the federal model, but employers and consumer advocates alike predict it will become the nation's benchmark for health insurance over time.
With the nation divided over President Barack Obama's health care overhaul law, and Republicans condemning it as a government takeover, the administration reacted cautiously to the recommendations.
Health and Human Services officials would hold listening sessions around the country before any final decisions are made, which could take months. The IOM panel recommended an extensive effort to engage the public.
Before they put forward a proposal, it is critical that they hear from the American people. The law extends coverage to about 30 million uninsured people.
Actually, work on the benefits package is already well under way within the HHS department. On the outside, a huge lobbying campaign to shape the final package is about to take off.
Employer groups - particularly those representing low-wage industries - want to keep benefits fairly basic. Since the government is going to be subsidizing coverage for millions of people, a generous plan will drive up costs for taxpayers, they argue. But consumer and patient advocacy groups that helped pass the overhaul law want to make sure their priorities are included.
The health care law requires that essential benefits include outpatient, hospital, emergency, maternal, newborn and children's care, prescription drugs, mental health and substance abuse treatment, rehabilitation, labs, prevention and wellness. But Congress gave the administration lots of leeway to determine the specifics.
In its 300-page report, the Institute of Medicine panel stressed that the package has to be affordable if Obama's overhaul is going to stand the test of time.
The panel used the analogy of a shopper at the supermarket. One option is to fill up your cart with all the groceries you want, and find out the cost at the register.
The first option compares to what the government now does with Medicare and Medicaid - it pays all the bills. But the advisers said Obama's plan should be on a budget.
The panel proposed a tough financial test. Few small employer plans currently offer comprehensive mental health coverage, for example. As such services are added, the total cost of the package should stay within a realistic budget target to be set by the administration. That would help keep premiums affordable.
The panel's rough estimate put annual premiums for individual coverage under the plan at $5,500 to $7,000 in 2014, comparable to what employers pay now.

Job’s Rare Form of Pancreatic Cancer

Story first appeared in the Associated Press.
Steve Jobs managed to live more than seven years with a rare form of pancreatic cancer that grows more slowly than the common kind. But his need for a liver transplant two years ago was a bad sign that his troubles with the disease probably were not over.
The Apple founder long kept information on his illness behind a firewall, and no new details emerged immediately after his death.
However, medical experts unconnected with his care say Jobs most likely needed the transplant because his cancer came back or spread. They said his death could have been from cancer, the new liver not working, or complications from immune-suppressing medicines to prevent organ rejection.
One doctor said a liver transplant can cure Jobs' type of cancer, but if it were to come back, it's usually in one to two years.
Jobs declared he was cured after surgery in 2004 for an islet cell neuroendocrine tumor, a much more treatable form of pancreatic cancer than the more common form of the disease that killed actor Patrick Swayze two years ago.
But the Apple chief never revealed whether the cancer had spread to his lymph nodes or liver, or how extensive his surgery was. Many doctors speculated he had a Whipple procedure, in which part of the pancreas, part of the small intestine and in some cases part of the stomach are removed and the digestive system is reconstructed.
Several years later, Jobs was dramatically thinner and gaunt. In January 2009, he attributed those problems to a hormone imbalance and said there was a simple treatment for it. A few weeks later, he went on a medical leave and then had a liver transplant that was kept secret for two months.
Even then, Jobs would not say why the transplant was needed, though doctors said spread of his cancer to the liver was the likely explanation.
Usually transplants aren't done for people with cancer, but there is some support for the idea that a liver transplant can be curative or a neuroendocrine tumor as long as the cancer has not spread beyond the liver.
Average survival for people with neuroendocrine tumors that have spread is seven to eight years, and some patients have survived 20 to 30 years.
It was not to be for Jobs.
In January, he announced his third and final leave of absence, and resigned in August.


Story first appeared in the Associated Press.

The nation's worst hospitals treat twice the proportion of elderly black patients and poor patients than the best hospitals, and their patients are more likely to die of heart attacks and pneumonia, new research shows.
Now, these hospitals, mostly in the South, may be at higher risk of financial failure, too. That's because the nation's new health care law punishes bad care by withholding some money, says the lead author of the study published Wednesday in the journal Health Affairs.
These hospitals are going to have a much harder time in the new funding environment. It is worried that they're going to get worse over time and possibly even fail, and that this will happen to several over the next three to five years.
Under the Affordable Care Act, hospitals that fail to improve will see their Medicare payments shrink by 1 percent starting October 2012. That could jeopardize some hospitals already on the brink of closure.
That unintended consequence of the health overhaul could increase health disparities for minorities.
The study shows that we have to make sure we pay attention to what the results of those policies are and be ready to change directions if they're causing harm in the marketplace.
The study doesn't name the 178 hospitals the researchers rated as "worst" because of their low quality of care and high costs. A data use agreement with Medicare prevented the researchers from identifying the hospitals publicly.
The study found 122 "best" hospitals with high quality and low costs. Those best hospitals were more likely to be in the Northeast, to be nonprofit and to have cardiac intensive care units compared to the worst hospitals.
Elderly blacks made up 15 percent of patients in the worst hospitals and about 7 percent in the best hospitals. There were similar differences for people on Medicaid, the state-federal health program for the poor. Worst-hospital patients with heart attacks or pneumonia were more likely to die than similar patients at the best hospitals.
Medicare chief called the study valuable, but not completely new. He said the federal government is working to help all hospitals improve.
The health law's so-called "value-based purchasing" rewards hospitals for their rate of improvement, not just for attaining goals. So hospitals that start farther behind can get rewarded for making efforts to catch up. And the law provides money for hospital improvement programs.
For the study, the researchers used data from six sources to determine which hospitals were worst and best. They divided the hospitals into four ranked groups for quality of care and divided them again into four ranked groups for cost.
Of 3,229 hospitals analyzed, 122 were in the top group for quality and also in the group that had the lowest costs. The researchers compared those hospitals to the 178 that were in the bottom group for quality and had the highest costs.
With the health law's expansion of insurance in 2014, patients may have more choice in hospitals. But most patients don't use tools like Hospital Compare to find the best ones nearby. Hospital Compare is a government website that rates how hospitals measure up to certain standards, such as giving heart attack patients aspirin.
People go to hospitals because they've always gone there or their families have always gone there or their doctors have always referred them there.
One person of the American Hospital Association said the group is worried about whether the new funding formula will put safety net hospitals at financial risk, but believes all hospitals can improve.

04 October 2011

Incentives to Lower Health Care Costs

Story first appeared in USA TODAY.
Sarah Gardner wants her company's employees to be savvy medical shoppers.
So this year, she rolled out a plan that sets limits on how much the company will pay toward a range of tests and procedures, from MRIs to hysterectomies. Workers at Buffalo-based Prodigy Health now know to call their employee insurance plan to find a list of local doctors and facilities that meet the price. Or they can choose to go to a higher-price center elsewhere in the insurer's network and pay the difference themselves.
Before the new program, workers' incentive to shop around was limited because they had no idea — or any easy way to find out — that prices for many types of medical treatments varied widely. A test at one center might be $3,700, while right down the street they could get it for $900. Prodigy provides benefit management for self-insured employers.
Other employers and insurers are pursuing the same strategy, experimenting with ways to slow rapidly rising spending on medical care. Some, like Prodigy, are going beyond simply offering high-deductible insurance to being more directive, using financial incentives to promote doctors, hospitals or medications they've deemed more cost efficient.
Safeway employees in the San Francisco Bay Area, for example, face higher payments if they choose centers that cost more than $1,500 for a routine colonoscopy. And in January, the giant California Public Employees' Retirement System (Calpers) said it would not pay more than $30,000 toward knee or hip replacement. Workers who choose a hospital that costs more pay the difference. Next year, the program will be expanded to outpatient colon cancer tests, as well as some surgeries, including cataract repair for the 345,000 people enrolled in Calpers' preferred provider plans.
Employers say they hope the efforts, often called reference pricing, will get patients to act more like consumers — and drive down the cost of some procedures.
This sends a signal to (medical) providers about what is considered a reasonable and acceptable price. These providers should also seek Hipaa Training.
Still, patient advocates fear the trend may leave workers not only footing more of the cost of health care, but also choosing among providers mainly with information on price, not quality.
Kathleen Stoll at the advocacy group Families USA worries that some employers may be simply picking an arbitrary number for the price they're willing to pay and not considering accessibility (of the centers) or quality.
Medicare, some private insurers and a few states track a few quality measures, such as mortality rates at hospitals, but there is generally little information on the outcomes of specific procedures, especially at facilities that are not part of a hospital, says Elliott Fisher, a Dartmouth Medical School professor well known for his research into quality and cost variation in medical care.
A lack of data on quality is a concern, as it is even with high-deductible plans, which can require workers to spend thousands of their own dollars before coverage begins.
The criticism has been that it's not fair to give people cost responsibility without the ability to make quality decisions. Maybe the $500 colonoscopy is done in a terrible factorylike environment, and the $1,200 one is better, but we don't know.
Gardner says her workers, many of whom are nurses, did raise the issue.
When she broached it last November their main concern was, “Are you going to send me to some low-quality provider just to save money?”
She countered by pointing out that the providers who met reference prices were ones employees were already using. Pretty much the places they suggest they go are the big places, the well-known places.
Checking medical claims
Before officially rolling out the program in March, Prodigy hired an outside firm called Healthcare Blue Book to comb through Prodigy's medical claims spending, looking particularly for tests and procedures for which there was high demand and wide price variation.
Working with the Blue Book information, Prodigy eventually settled on nine broad categories of tests or procedures that would fall under the new program. Included are imaging services, such as computed tomography (CT scans), sleep apnea tests and some non-emergency surgeries, including arthroscopic knee procedures. What Prodigy pays for each service varies based on local costs in the cities where its 1,200 covered employees live, including Buffalo; Minneapolis; Columbus, Ohio; Evansville, Ind.; and Okemos, Mich.
The rate is set at about the median (half were higher and half were lower) that Prodigy had paid in the past for the services. About 90% so far have chosen to go to medical providers who meet the price limits, she says. The rest go to higher-price centers and pay the difference themselves.
In the program's first two months, Prodigy saved an estimated $17,000. But Gardner says her main goal is not so much saving money as arming workers with information and getting them to pay attention and ask questions.
Facing challenges
The idea of having employees pay the difference for higher-cost services is not new. About 39% of large employers surveyed in an August National Business Group on Health report said they use the technique in their prescription-drug programs, often by requiring workers who want a brand-name drug when a generic is available to pay the difference. Some employers encourage workers to use high-performance networks of doctors or hospitals by lowering their co-payments if they seek care there.
But only about 1% of employers in the August survey use reference pricing like Prodigy, for lab tests, radiology exams or other medical services.
The approach faces challenges. For one thing, it can be hard to explain to employees. Prodigy, for example, hired someone solely to help workers select a facility that meets the price limits.
Also, patients may be hesitant to question their doctor about costs or reluctant to switch to a different physician or hospital.
Focus groups show that people generally don't like shopping around for health care.
It's one thing to go from store to store to see how much toilet paper costs, but with doctors, you don't have an easy way to find out. It feels unnatural and uncomfortable to ask a doctor how much they would charge.
Still, the trend is further fueling efforts by employers and other groups to push for more quality data, Lansky says. He recalls a recent conversation with members of the American Gastroenterological Association who are developing a registry that will eventually track the quality of colonoscopy providers. They don't want to see a market where (only) the cheapest places do well. They want to reward physicians who are doing high-quality care and put in place a system that makes that visible.
Checking on doctors
Consumers can't yet check the registry to find out if their doctor does a better job than one across town. But it is under development.
Anthem, the insurer running the new hip and knee program for Calpers, says it will track the outcomes to make sure they are at least as good as what was seen before the change. About 90% of the hospitals in Anthem's California network met the reference price for hip or knee replacement, including Cedars-Sinai, UCLA and other well-known medical centers.
Anthem provides transportation costs for patients who live too far from one of the centers. About 77% of the covered workers having the procedure since launch have gone to a reference-price hospital.
The 46 hospitals were chosen after Calpers analyzed what it was paying for hip and knee replacements under its previous arrangement and found it ranged from as little as $15,000 to more than $100,000.
The $30,000 limit for hips and knees is not a median but was selected after looking at the range in costs and taking off the really high and really low numbers. The program should save Calpers about 20% of the cost of the procedures.
This is the future for select procedures where people can shop.

03 October 2011

CareTech Solutions Invests $1.5 Million in Hospital IT Help Desk

Company’s Service Desk Undergoes Major Renovation in Preparation for Growth Explosion

(TROY, Mich., Sept. 29, 2011) CareTech Solutions, an information technology (IT) and
Web products and services provider for U.S. hospitals today unveiled its newly re-configured and remodeled Service Desk, a 24x7x365, on-shore medical help desk that currently responds to nearly one million contacts a year from hospital users seeking IT support with clinical and business systems. The $1.5 million investment enables additional growth and hiring for the Service Desk which is on track this year to experience twenty five percent growth in revenue.

“The Service Desk is the fastest growing piece of our business, largely due to the recent explosion of electronic medical records and healthcare technologies,” said Jim Giordano, president and CEO, CareTech Solutions. “Service Desk is more than a call center, it’s a highly-specialized technology support organization with analysts trained to quickly resolve doctors and clinicians’ IT issues so they can get back to what they do best, caring for patients.”

The Service Desk, based in Troy, Michigan, was launched by CareTech Solutions in 1998 with less than 30 employees. In 2008, CareTech added a dedicated physician-only hotline, remote control tools, and a knowledge base that holds over eight thousand answers for all major clinical systems and business applications. Today, the Service Desk staff has grown to almost 160 employees, with more than 45 added this year.

About CareTech Solutions
CareTech Solutions, Inc., an information technology and Web products and services provider for more than 180 U.S. hospitals and health systems, creates value for clients through customized IT solutions that contribute to improving patient care while lowering healthcare costs. From implementing emerging technologies to supporting day-to-day IT operations, CareTech offers clients expert health information management services across the entire patient data lifecycle earning it the 2008, 2009 and 2010 Best in KLAS award for IT Outsourcing (Extensive) as ranked by healthcare executives and professionals in the Top 20 Best in KLAS Awards: Software & Professional Services report.

For more information, please visit www.caretech.com.