States now are looking at adults between the ages of 19 and 29 as they seek to reduce the number of uninsured. In the past two years alone, 17 states have passed laws that let young adults stay covered under their family policy until their mid-20s. Age limits range from 24 in Delaware, Indiana and South Dakota, to 30 in New Jersey. Eleven states settled on age 25, according to the Commonwealth Fund.
Google Inc. will begin storing the medical records of a few thousand people as it tests a long-awaited health service. The pilot project will involve 1,500 to 10,000 patients at the Cleveland Clinic who volunteered to an electronic transfer of their personal health records so they can be retrieved through Google's new service. Each health profile will be protected by a password that's also required to use other Google services such as e-mail and personalized search tools.
Colorado is one of just five states that do not license home healthcare providers, and the state health department says the inability to set minimum standards of care and perform inspections is resulting in increasing instances of deficiencies. Abuses by home caregivers have been revealed in a new state report that is prodding lawmakers to seek more oversight of the industry. Recent legislation would require agencies providing nursing, physical therapy and basic caregiving in patients' homes to be licensed by the state.
Entrepreneur buys up sites for individual cities, creating YourCity.MD, a network of about 300 city-specific healthcare Web sites. The creator is willing to wager that consumers looking for a new doctor, a flu shot or a referral for shoulder surgery will flock to the sites, and anticipates that 200,000 doctors who will be using the site by the end of the year.
The Supreme Court made it harder for consumers to sue manufacturers of federally approved medical devices. In an 8-1 decision, the court ruled against the estate of a patient who suffered serious injuries when a catheter burst during a medical procedure. The case has significant implications for the $75 billion-a-year healthcare technology industry, whose products range from heart valves to toothbrushes. In a recent three-month span, federal regulators responded to over 100 safety problems regarding medical devices.
Gov. Charlie Crist will ask the Legislature to help millions of Floridians who have no health insurance by inviting private companies to offer a range of coverage options at reduced cost. But the initiative, laid out for the first time in an e-mailed news release, lacked key details, making it far from clear if Crist's effort would significantly address a problem that has vexed health experts nationwide. Nearly 1 of 4 Floridians under age 65 has no insurance.
Two small rural hospitals in Southern Illinois, Washington County Hospital in Nashville and Salem Township Hospital in Salem, are creating a community-wide medical information exchange that will allow physicians, hospitals and other medical providers to electronically share patient information. The partnership establishes a network of health communication that many larger, more urban areas, including St. Louis, have failed to do.
Relentless medical inflation has been attributed to many factors--the aging population, the proliferation of new technologies, poor diet and lack of exercise, the tendency of supply to generate its own demand, etc. However, public policy researcher Robert Kuttner offers a second opinion. He says the extreme failure of the United States to contain medical costs results primarily from our unique, pervasive commercialization.
Editor's note: This is the first in a two-part series on the emerging market opportunity in musculoskeletal services. This week's article focuses on the factors driving the developing market. Next week's article will discuss how to prepare for key trends in the market and develop a program that will contribute to your bottom line.
Today, more than one-third (37 percent) of the U.S. population is 45 years of age or older. In a little more than 10 years that percentage is projected to increase from 37 percent to 42 percent, and account for more than 118 million people. By 2017, the leading edge of the baby boom will be entering their early 70's. This "never grow old, chase the dream" generation, which has reinvented every industry it has interacted with for more than thirty years, will seek healthcare services that promote good health and longevity, as well as support an active lifestyle. Chief among their needs will be musculoskeletal and orthopedic services.
A Growth Opportunity Combine an aging population with technological advances in orthopedic care and devices, and the stage is set for unprecedented demand and increased opportunities for healthcare providers. Consider that the volume of musculoskeletal procedures increased by 24 percent between 1997 and 2005; spinal fusions increased by 73 percent, knee arthroplasties by 60 percent, and hip replacements by 32 percent. And, according to the Agency for Healthcare Research and Quality (AHRQ):
More than 3.4 million procedures were performed in U.S. hospitals in 2005, representing 8.6 percent of all hospital discharges.
Estimated expenditures for musculoskeletal procedures totaled $31.5 billion; more than 10 percent of total hospital revenues.
Over the next 10 to 20 years, we will see even more dramatic growth. The number of adults with arthritis (one of the leading drivers for musculoskeletal services) is expected to rise from 46 million in 2005 to 67 million by 2030. Physicians cited in a recent Journal of Bone and Joint Surgery article projected that primary and revision hip and knee arthoplasty procedures would double by 2030.
Several other factors also contribute to this developing market:
Improved screening and diagnostic imaging enables earlier patient identification, diagnosis and initiation of treatment for musculoskeletal conditions.
Today's rapidly evolving technology is resulting in higher-quality, more specialized medical devices and products that enable physicians and specialists to be able to recommend surgery as a proactive response rather than a last resort.
Direct-to-consumer advertising is also playing a role in providing consumers with an unprecedented amount of information on their conditions and medical treatment options. For example, medical device companies are bypassing surgeons and physicians and marketing new joint implants directly to consumers. The effect is that educated consumers are proactively approaching physicians and asking for medical services--and products--by name.
As a result, the median age for surgical interventions is dropping. While knee arthroplasty and hip replacements are performed typically in patients in their upper 60's, the mean age of spinal fusions was 52.
In these days of continuous revenue and margin challenges, musculoskeletal medicine can be--for those institutions with the will, fortitude and quality medical staff to pull it off--the next big growth opportunity. Next week we'll discuss the key trends in this market and what hospitals must do to take advantage of the opportunity.
John Kessler is vice president of The Strategy Group in Norfolk, VA. He is a consultant, speaker and author. He may be reached at kessler@thestrategygroup.com.
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After a second-place finish in the Iowa caucuses, John Edwards approached the microphone to present one of his classic "Two Americas" speeches.
Knowing he was not only speaking to a couple hundred supporters in Iowa, but millions across the nation, Edwards dipped into his campaign quiver and pulled out his first arrow. He pulled back his bow and the arrow pierced the air and struck directly into the heart of managed care.
The former senator retold the story of Nataline Sarkisyan, a 17-year-old leukemia patient at the Pediatric Liver Transplant Program at UCLA. Everyone in managed care surely knows the story. Her insurer, CIGNA, declined a liver transplant for the teenager, who suffered from multiple organ failure after a bone marrow transplant. The insurer said it "does not cover experimental, investigational and unproven services." The company's decision sparked protest from her doctors and nurses and brought picketers to the managed care company's Glendale, CA, offices.
CIGNA ultimately gave the OK, but it was too late. Sarkisyan's family had already taken the girl off life support, and she died shortly after the insurer's decision. The tragic story is yet another example of health insurers being on the wrong end of the news. How has managed care become such an easy applause line for politicians?
There was once a time when managed care was not known for funding CEO bonuses, asking physicians to rat out patients and paying fines following improper denials. In fact, there was once a time--believe it or not--when managed care was considered the guys wearing the white hats.
The early days of managed care were tough times for doctors and hospitals. Most lower-income Americans (and even one-quarter of those in the upper-income brackets) delayed seeing a doctor during the Depression. Those patients who did visit their physicians often did not pay their bills promptly. In fact, Americans were paying department and grocery stores, landlords, and dentists before their physicians. Less than 5 percent of families accumulated one-third of the country's medical costs. Fewer patients and delinquent payments crippled the healthcare system because there wasn't enough money to pay physicians and hospitals.
The nation turned to an option that had been promoted occasionally for the first few decades of the 20th century--health insurance. Supporters preached that health insurance would not only help patients pay for their care, but provide a steady stream of money for physicians and hospitals, which faced empty beds and unpaid bills.
Not everyone was sold on insurance though. The American Medical Association was concerned that managed care would place barriers between patients and their doctors. But a growing number of physicians, particularly those in rural areas, saw that their patients simply didn't have the resources to pay their bills.
Without a regular stream of income, doctors and hospitals were sinking. Health insurance jumped into the lifeboat and saved a drowning healthcare system. Now, here we are 70 years later. Many Americans no longer view managed care as a necessary piece of the healthcare system, but as an expensive third wheel that--as the AMA had warned--places barriers between physicians and patients.
The arguments against health insurers are easy to understand. No one wants to be denied life-saving services, and many worry about what will happen to them and their loved ones in their greatest time of need.
But what would happen if managed care was wiped from the system--especially in these days of foreclosures and credit card debt? Imagine returning to the days of individuals paying for services. Few want a healthcare system without managed care, but Americans are not satisfied with their current healthcare.
Even the most ardent health insurance defender would acknowledge managed care isn't perfect, but the system continues to serve its purpose--as the difference between this nation protecting its people and slipping back into the days of empty hospitals and delinquent payments.
