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Today’s Managing Health Care Costs Indicator is 0 Health Care for All, an advocacy group that played a substantive role in passing health care reform here in Massachusetts, has come out in favor of a health insurance premium freeze .    They cite the case of Sarah Higginbotham, who says her biweekly take-home pay for a part time job at a church used to be $900, but has dwindled to $164 since she now has a family plan and health insurance premiums have risen by double digits each year. Premium increases are caused by a combination of increased unit prices, increased utilization, increased intensity of services, and increased burden of illness.  Price increases could be substantially decreased or eliminated quickly, although that might take price controls .   Lifestyle change can lower burden of illness, but not by 2012.  Increased utilization can be changed – but takes some time.  Increased intensity of service sometimes represents innovation...

Today’s Managing Health Care Cost Indicator is $8.76 billion The Obama Administration announced yesterday that it would halt its “mystery shopper” survey,  which would have assessed potential primary care access problems.   Under the program, a survey company would have called physician offices three times – posing as a new patient with an urgent problem (coughing up blood) or a routine need (annual physical exam).    The  mystery shopper survey would have sampled just under 5000 physicians in 9 states, and about 500 of them would have gotten a third call,   asking on behalf of the Department of Health and Human Services if the office accepted private insurance, public insurance, and self-pay patients.   Physicians expressed anger at the proposed mystery shopper survey – likening it to “snooping” and “Big Brother.”   One physician said Is this a good use of tax money? Probably not. Everybody with a brain knows we do not have enough doctors. The...

I don’t know about you but the politicians are starting to scare me with their inability to make progress in the federal debt limit discussions. Worse, is the apparent eagerness of some to actually take the government to default to make a political point.I know a lot of conservatives say missing the August 2 deadline isn’t a big deal but I think it is.The 2011 deficit is projected to be $1.6

Today’s Managing Health Cost Indicator is 3403 Today’s Boston Globe  highlights the full court press the Massachusetts biotechnology industry is making to convince Senator John Kerry to oppose the Independent Payment Advisory Board, Section 3403 of the Affordable Care Act.   The IPAB, which is opposed by drug companies, some physicians, and the biotechnology companies, would create an independent board which would make recommendations for lowering Medicare costs if those costs continued to increase.   Congress would have to vote these recommendations up or down without amendment – like military base closings.   The current debt ceiling debate shows how hard it is for Congress to lower the cost of the federal government – and many of the necessary solutions to our escalating health care costs will be easily subject to demagoguery like claims of “death panels” and “bureaucratic government throttling private-sector innovation.” Henry Aaron, in this week’s New England J...

Today’s Managing Health Care Costs Indicator is 98.1% Click to enlarge image There has been a lot in the national press about how health care reform in Massachusetts has worked.   There's a lot of blather on both sides of the political spectrum, and the Boston Globe   had a comprehensive article today reviewing how “RomneyCare” is working here.   Conclusions: 1) Far more people are insured than before health care reform, despite the disastrous recession (98.1%) 2) More employers (up from 70 to 76%) are offering insurance, again despite the recession 3) The exchanges work for individuals - they haven't worked well for small employers yet 4) The cost of the care of the uninsured has declined. 5) There is inadequate primary care access, and ED visits have gone up rather than down. 6) The cost has been manageable - but the state has relied on some payments from the feds (stimulus dollars and Medicaid add-on dollars) that will not continue. The federal government has paid a ...

Just a brief note.  The Supreme Court agreed with my post from a few months ago  and will allow pharmaceutical companies to purchase data on physician drug prescribing practice. The vote was 6-3; Sonia Sotomayor joined Anthony Kennedy and the four pro-business conservatives. I think having more of this data collected in a standard way will be good - and eventually will help us improve prescription practices.  I'd like to see this data available in patient-friendly ways. In an era of high patient cost-sharing, patients will start wanting to know if their doctor is making cost-effective prescription choices.

Today’s Managing Health Care Costs Indicator is 10% Martha Coakley, the Massachusetts Attorney General, just released her 2011 report on health care in the Commonwealth. The AG’s office delivered civil investigative demands, the equivalent of a subpoena, to three major health plans and 16 different provider organizations.  They then reviewed payment rates among the plans and providers, and incorporated health plan risk adjustment in their analyses.  They also reviewed available quality data – which showed little correlation with cost. There are 55 pages of gems here – and I’ll talk about the relation of wealth and health care costs in a future post.  The news reports I’ve heard so far have concentrated on disparities of provider payments – with some providers getting payments as much as twice as high as others.  The AG’s office concludes that addressing price inequities was a prerequisite to lowering the cost of health care, and that moving to global or bundled paym...

Today’s Managing Health Care Costs Indicator is   19,900 The NY Times  on Friday had a deeply disturbing article on a murder that stunned the mental health community here in Massachusetts.    A long-term schizophrenic man, off his medicine and spiraling into incoherence, killed a young female counselor who was the sole worker at a group home in a Boston suburb.   His mother, who works at a Boston teaching hospital, was frantic with worry as her adult son, who had been arrested for assault multiple times, was becoming more psychotic.    It was hard for her to get anyone’s attention. The counselor was the first in her family to get a college degree, and had just decided to go to nursing school.    Now she’s dead – and her family had trouble scraping together the resources for a burial.   The schizophrenic will be imprisoned for the rest of his life – which ironically could be the best chance for him to get appropriate medical care. Both...

Today’s Managing Health Care Costs Indicator is 75,000 Saturday’s New York Times  had a great example of using variation to identify waste in the health care system It’s almost never necessary to do two chest CT scans in a single day – one without contrast, the other with contrast.   The ordering physician should know in advance whether she is looking for disease that requires imaging of the vasculature system.  It’s bad to do sequential chest CT scans of patients for at least three reasons.  Each chest CT scan is the equivalent of 350 chest x-rays – and we should avoid the extra radiation exposure, which does cause some cases of breast and lung cancer. The  cost of CT scans is high – CMS reports that these duplicate CT scans cost Medicare alone $25 million.  Doing extra tests poses the danger of finding “incidentalomas,” findings that are not relevant to health, but that require additional tests which pose new health risks and additional expenses...

I call your attention to Ezra Klein’s column in the Washington Post this morning.In it he cites data that has been out there for a long time but Ezra puts some perspective on it that never occurred to me before.Examining the Kaiser Family Foundation brief, “Health Care Spending in the United States and Selected OECD Countries” he points out, “Our government spends more [as a percentage of GDP] on