A new report shows the quality of medical care varies widely at clinics and hospitals across the Puget Sound region in Washington State, with many patients failing to get basic treatment recommended by national guidelines. Nearly half of clinics surveyed were below average at ensuring patients with diabetes got regular eye exams to detect vision problems caused by the disease. The percentage of heart-surgery patients who received standard treatment to prevent blood clots ranged from 59% to 96% at hospitals. The findings were released in the Community Checkup report released by the Puget Sound Health Alliance.
WellCare Health Plans Inc., Florida's largest provider of managed healthcare for the poor, expects its net income to drop substantially in the first nine months of 2008 because its increased enrollment hasn't offset added medical benefits costs. As of Sept. 30, WellCare's total membership was 2.5 million, an 8% increase from membership of 2.3 million on the same day a year earlier. The membership gain is expected to boost revenue, but that likely would be offset by an increase in the cost of providing medical benefits.
California's budget woes could leave thousands of California children on a waiting list for healthcare, as state officials who oversee the Healthy Families Program are scrambling to find ways around a $17.2 million budget shortage. The program provides low-cost health, dental, and vision coverage to uninsured children of working families.
Illinois Gov. Rod Blagojevich's administration will start paying healthcare providers again after the state Supreme Court put a temporary hold on a judge's order to shut down an expansion of the state's FamilyCare program. The decision marked the latest twist in Blagojevich's attempt to expand state-subsidized healthcare without lawmakers' approval. The governor's unauthorized expansion allowed families of four making up to $83,000 a year to get coverage, but his administration was then sued by two prominent businessmen and a lawyer to stop it.
A 2005 Illinois law limiting the amount of money juries may award in medical malpractice cases unfairly targets those most seriously injured who deserve the most compensation, lawyers have told the Illinois Supreme Court. Proponents of the law asked the court not to limit what they called lawmakers' attempt to stem a healthcare crisis. The law restricts awards on non-economic damages to $500,000 against doctors and $1 million against hospitals. It was aimed at lowering medial insurance rates blamed for driving physicians out of the state.
A group of labor unions is launching a campaign that accuses CVS Caremark Corp. of violating patient privacy and improperly pushing doctors to prescribe a costly prescription drug. Change to Win, a group of unions that represents about six million workers, said CVS's pharmacy benefits management business has been urging doctors via a letter to add Merck & Co. diabetes drug Januvia to patients' treatments. The letter said CVS identified the diabetes patients through a review of prescription-drug claims processed by its Caremark unit.
The University of Texas Medical Branch in Galveston will lay off about 3,800 workers because it is running out of money. The University of Texas Board of Regents said in a news release that the hospital would have no money to operate in about three months at its current spending rate. Ike caused nearly $710 million in losses to the hospital when it struck the Texas coast in September and officials have said insurance covered only about $100 million of that.
Chronically ill patients in the United States spend more out-of-pocket money, skip needed care, and report more medical errors than patients in seven other industrialized countries, according to a survey from the Commonwealth Fund. For the survey, researchers interviewed 7,500 people who had at least one chronic condition. The countries in the survey were Australia, Canada, France, Germany, Great Britain, the Netherlands, New Zealand and the United States. All of those surveyed had recently been hospitalized, had major surgery or a recent serious illness.
Throughout the presidential campaign, words like "sweeping" and "ambitious" and "reform" have been commonplace in descriptions of President-elect Barack Obama's healthcare agenda. But in recent weeks—and especially since Obama was elected—some very different words have been popping up in discussions of what the next president will really be able to accomplish in the healthcare arena: "incremental" and "phased" and "limited," to name a few.
With a struggling economy and two wars draining resources and leaving much less money to work with than Obama no doubt envisioned, the general consensus from analysts around the country is that Obama's lofty plan—there's another descriptor, "lofty"—will be scaled back considerably. We have a story coming on this topic in December's issue of HealthLeaders magazine, but in short, creating a public plan for the uninsured and expanding SCHIP and expanding Medicaid and investing billions in healthcare information technology and doing everything else Obama wants to do would require, as all of you know, hundreds of billions of dollars—some estimates say more than $1.5 trillion over 10 years.
And when it comes to changing the U.S. healthcare system, our next president has more to worry about than just money. "He is going to face a very difficult road in any event, given the current budget situation and given the projected long-term budget situation and given the complexity and political difficulty of making major changes in so large of an industry," says Henry Aaron, a senior fellow at the Brookings Institution. "We can't afford healthcare reform. But the principal obstacle to achieving it is not the cost but the complexity of the interests and the policy changes involved in healthcare reform."
OK. So a presidential candidate may not be able to deliver everything he promised during the campaign. In the words of Gomer Pyle: Surprise, surprise, surprise. But what about the quality arena specifically? Is the industry likely to see any significant movement?
Here's an abbreviated review of Obama's quality agenda, summarized from his Web site:
Promote patient safety—require providers to report preventable errors.
Align incentives for excellence—providers seeing patients enrolled in the new public plan will be rewarded for achieving performance thresholds.
Comparative effectiveness reviews and research—establish an independent institute to oversee research on comparative effectiveness, with research focused on comparative information on drugs, devices, and procedures to determine which options create the best outcomes.
Tackle disparities in healthcare—tackle the root causes of health disparities by addressing differences in care access; promote prevention efforts; require hospitals and health plans to collect and analyze quality data for disparity populations.
Reform medical malpractice while preserving patient rights—strengthen antitrust laws to prevent insurers from overcharging physicians for their malpractice insurance.
At first glance, some of these seem painfully obvious and read like so much campaign propaganda. "Promote patient safety." Really? What a novel concept. "Tackle disparities in healthcare." In the description of how that will be accomplished, verbs like "address" and "promote" reek of trivial generalization.
Still, patient safety is, in fact, a critical issue. Disparities in care access do exist. And aligning incentives for quality care is a noble idea (assuming the "incentives" are meaningful). In other words, the issues are basically on target. But Obama is likely to encounter the same conflicting agendas and same monetary challenges in implementing quality initiatives as he does with the rest of his plan. Personally, I don't see a lot of slam dunks here. Actually creating an independent institute to oversee research on comparative effectiveness, for example, will face both strong financial headwinds and resistance from people who don't think it's a good idea, anyway. I do agree, however, with the general consensus that momentum remains strong for reform of some kind, even if it is more limited and protracted than Obama's early campaign promises.
What do you think? Which parts of Obama's plan have a real shot, and which parts are already doomed? Send me an e-mail and let me know your thoughts.
Jay Moore is managing editor for HealthLeaders magazine. He can be reached at jmoore@healthleadersmedia.com.
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I'll bet you thought you wouldn't hear that phrase again so soon after the election.
But now that we know which party will be setting the healthcare agenda for the next four years and the discussion about reform has shifted from abstract goals to a more concrete framework for change, a debate over income redistribution has ignited within the physician community.
The spark came at the AMA's interim House of Delegates meeting this week, where members voted to make permanent Medicare physician payment reform a top priority for its 2009 legislative agenda. While physicians across the board agree on most of the proposals discussed—expanding the medical home model, providing quality incentives, adjusting the Medicare sustainable growth rate—the controversy stems once again from the question of how to fix primary care.
According to Bob Doherty of the ACP, specialists were lining up at the microphones during the discussions to express support for primary care "as long as it doesn't involve redistribution of dollars among physicians."
This is a sentiment expressed before, and it has nothing to do with which party is controlling the government. Because of Medicare's budget neutrality requirements, high-earning specialists are worried that much-needed increases in primary care reimbursement will lead to a corresponding decrease in their pay.
Cardiologist Westby G. Fisher, MD, explains it more bluntly from a specialist's perspective: "Most of us already know what the Robin Hoods of bureaucracy are going to do: steal from the rich (specialists) and give to the poor (generalists)."
Primary care physicians don't see it that way. Judging by some of the hostility expressed on other physician blogs recently, they feel their work is undervalued, and in some cases that specialists are overpaid.
Kevin Pho, MD, warns that this division will escalate and "class warfare is going to hit the medical profession real soon, and it's going to be ugly."
That's the last thing we need right now.
The healthcare industry has a unique window of opportunity to address some of its problems, and there's a danger of that being squandered by factions working toward different self-interests.
There are without a doubt some difficult questions to answer. Can some primary care services be provided by non-physicians? Are specialty procedures overvalued and overpriced? How will patients receive primary care if the shortage isn't addressed?
But the key is to look at these questions based on what's best for the overall healthcare system, not individual physician factions. Whether you agree with his policies and politics or not, it's worth taking a lesson from President-elect Obama's notion in last week's acceptance speech that "we rise and fall as one."
If inter-specialty bickering stalls reform, the overall system suffers. If primary care fails, patients won't get the care they need. Ensuring that doesn't happen should be something all physicians, regardless of specialty, can agree on.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.Note: You can sign up to receive HealthLeaders Media PhysicianLeaders, a free weekly e-newsletter that features the top physician business headlines of the week from leading news sources.