DOCTOR PUNDIT

Paper: Employees Increasingly Burdened by Dwindling Employer Benefits

Michael Douglas, MD, MBA — Thu, 02 Sep 2010 19:16:52 +0000

Another sign that the economy is mired in muck, with prospects for improvement any time soon being very dim:

A new survey shows a family health plan in 2010 averages $4,000 a year, up 14% from 2009. Meanwhile, the average employer contribution to a family plan hasn’t increased at all. [...] Overall, premium growth slowed slightly this year to 3%, with the average annual cost of a family health plan reaching $13,370. Workers picked up 30% of that bill. The average plan for a single individual cost $5,049.

Slow job growth. Incremental premium increases. Higher out-of-pocket expenses for care. Forget about cost-sharing. This is massive cost shifting, and healthcare consumers are being forced to take the brunt of the cost of that coverage. | LINK

Unemployed Workers Feel Extreme Burden of Maintaining Previous Employer Coverage Unemployment carries with it all of the mystery of Pandora’s...
Wal-Mart Appears to Be Embracing Employer-Mandated Health Coverage for Employees Today has started off with a double take at the...
Health Reform Law Forces Corporate America to Reevaluate Taxable Benefits for Retired Employees Corporate America is wasting no time rethinking retirement plans for...

Small Business Poised to Benefit Under Reform

Michael Douglas, MD, MBA — Thu, 02 Sep 2010 13:12:49 +0000

In the nascent days of Pres. Obama’s reform legislation, much in the way of healthcare policy at the start of this crucial decade proceeds incrementally. With respect to the role of small businesses, expect the use of targeted tax credits for employees as another incentive for the smallest of those private proprietorships to remain viable in both the healthcare economy and the economy in general. It’s all about baby steps and getting skin the health reform game at the outset. The Congressional Budget Office estimates the credits could give up to $40B in savings to small businesses over the next 10 years and lower annual premiums by approx. 10 percent by 2016. | PDF LINK to Commonwealth Fund white paper

Small Business Coverage Benefits Could Be Missed in Final Reform Bill Republicans have always been on the side of small businesses....
Mass. Governor Announces Plan to Help Small Business in State’s Turbulent Universal Coverage Environment One thing that Massachusetts has learned from its experience as...
Lawmaker Searches for Transparency in Big Business’ Claim of Costs as a Result of Reform Law Corporate employers and their assertions that the newly signed healthcare...

From the Research Mill, All Things Cancer

Michael Douglas, MD, MBA — Thu, 02 Sep 2010 01:02:16 +0000

Lately, Doctor Pundit has been reporting some tidbits from the arena of medical research. Here are a few more to make the wires for 9/1.

Is it really possible? For now you’ll just have to ask the mice taking it. Metformin, the country’s most widely used antidiabetic agent, could lead to the prevention of lung, breast, and prostate malignancies. | LINK
Speaking of cancers, are certain heritable forms of breast cancer prevented by a certain surgical technique? | LINK
Again, on the topic of cancer: an anti-tumor drug may be altered to serve as the basis for a novel agent to prevent the formation of senile plaques seen in the central nervous system in virtually all Alzheimer patients. | LINK
Finally, on the lighter side of things — the all-star line-up for the “Stand Up to Cancer” telethon is almost finalized. | LINK

Does Prostate Cancer Screening Overdiagnose Cancer? Here’s an age-old question: do too many men have prostate...
Patient Advocacy Group on Prostate Cancer Gets Serious about Prevention – Zero prostate cancer deaths. Zero prostate cancer cases and for...
Pharma Company’s Research Actions May Have Short Term Setback in Alzheimer Research Pharma company Eli Lilly recently scrapped further development of an...

Groups: Mandatory Yearly Influenza Vaccine for All Healthcare Workers

Michael Douglas, MD, MBA — Tue, 31 Aug 2010 20:40:35 +0000

The huge drive to immunize the masses against threat of H1N1 in the 2009/10 influenza season (which the WHO has officially declared concluded) has created more than a watershed moment in 21st century public health response to a potential biological catastrophe, it has also touched off a political debate that’s just getting started. And it all has to do with authoritarian mandate of the vaccine for healthcare workers.

Contrary to popular thought, many healthcare workers do not receive the vaccine; in fact, approximately 40 percent of said workers actively refused [PDF link] the vaccine last year — during infection’s peak. This notion does not sit well with a couple of policy organizations — one academic and one medical. Both groups say mandatory influenza vaccine should be a condition of employment. The groups stress increased availability of the vaccine, a steadier supply of healthy workers to administer care in times of a crisis, and an overall decrease in the incidence of influenza-related deaths in already compromised inpatients with other medical problems.

Already, the state of New York is hard at work in developing regulatory actions for its public healthcare workers. | LINK

Monday Newswire: MN’s First Influenza-A Case & More NY state recoups over half a billion dollars in amounts...
German Government Critic Alleges WHO Exaggeration of H1N1 Threat, Cites Oversupply of Vaccine Given time, anything can be politicized. Take the hysteria surrounding...
CDC Updates Projections on Influenza Deaths Just how effective are vaccines at keeping mass pandemics of...

Study: Preponderance of Medical Imaging Due to Overutilization

Michael Douglas, MD, MBA — Tue, 31 Aug 2010 10:38:19 +0000

The massive increase in procedures over the past 20 years has added to the cost of providing care, to no one’s surprise. A study in the recent Radiology journal acknowledges this.

Part of the explosion in medical imaging over the past two decades may be attributable to overutilization, and steps need to be taken to cut back … Imaging services and their costs have grown at about twice the rate of other technologies in healthcare including lab procedures and pharmaceuticals…

Part of the problem fueling this growth has been the inclusion of many non-invasive standard imaging techniques as being procedure based — lumping the costs associated with uncomplicated, unenhanced CT imaging with, say, CT-guided renal biopsy — for example. Of course, bordering on the unethical side are the practices of self-referral within large imaging groups in many healthcare markets. | LINK

CDC: The Use of Imaging Studies in Emergency Medicine Up 4X in Fifteen Years It’s often said that the beleaguered emergency department (ED) is...
Study: Elective Angiogram Finds Coronary Disease in about a Third of Cases It’s one thing for medical researchers to suspect an answer...
Study: United States Falls Short on Quality of Healthcare Delivery Compared to Other Nations A study commissioned by the Commonwealth Fund confirms for some...

Another Spin on Concierge Medicine Could Renew Interest in Motivated Practices

Michael Douglas, MD, MBA — Mon, 30 Aug 2010 10:43:34 +0000

The application of the philosophy that is at the core of medicine: first do no harm — is a little at play in an article in the NYT. The rise of so-called concierge practices in the wake of healthcare reform has touched off a debate of sorts on the ethics of delivering such care. That is, you essentially pay for what you get — nothing more, nothing less. Perhaps its the myriad names by which its central workings are known that give it some ethical cover: membership medicine, concierge health care, cash only practice, direct care, boutique medicine. These terms convey one basic fact — the patient pays an annual fee (with other possible charges). In exchange for the retainer, doctors provide enhanced care.

[I]t’s hard not to wonder whether it is possible to practice in a way that reconciles concierge medicine with all the ethical concerns. One group of doctors in Boston believes it is possible. [...] But unlike other boutique practices, the retainer fee of $1,800 per year that these patients pay does not go directly to the doctors’ coffers. Instead, it is used to support the traditional general medical practice, the teaching of medical students and trainees and free care to impoverished patients.

Thinking of the delivery of this type of “specialized” primary care in which fees go to the process of delivery itself before direct provider revenue is another way some primary care practices hope to regain some lost footing in practices on the brink of dissolution or acquisition under the brave new world of reform. For some of these practices, for now, arrangements seem to be paying off — ethically, if not fiscally. | LINK

Maryland Insurers Group Releases Reimbursement Guidelines on Providers of Concierge Primary Care A report [PDF] obtained by the Baltimore Sun examines the...
In an Abundant Managed Care Market, a Young Physician’s Simple Quest to Just Practice Good Medicine The battle to preserve both quality healthcare delivery and access...
Formal Training in Business of Medicine Slowly Permeates Undergraduate Medical Education Schools of medicine have largely remained timid about the introduction...

CDC Updates Projections on Influenza Deaths

Michael Douglas, MD, MBA — Sun, 29 Aug 2010 16:13:05 +0000

Just how effective are vaccines at keeping mass pandemics of infectious disease abated? Well, it may not be so easy to estimate.

[T]he number of annual flu-related deaths in the United States has ranged from a low of about 3,300 to a high of about 49,000. This is a revision of the static estimate of 36,000 annual deaths that has been reported consistently for years by the U.S. Centers for Disease Control and Prevention.

The CDC has revised its projections on the preventive care of the seasonal influenza vaccine, moving from statistical dead targets to ranges of mortality among influenza outbreak figures. Its projections cover most of the past 30 years (up to 2007, and not inclusive of last year’s H1N1 pandemic). | PDF LINK to latest issue of CDC’s Morbidity & Mortality Weekly

Monday Newswire: MN’s First Influenza-A Case & More NY state recoups over half a billion dollars in amounts...
UK Study: Drugs Used in Alzheimer Patients Double Risk of Mortality What should I do as a physician rounding on one...
Groups: Mandatory Yearly Influenza Vaccine for All Healthcare Workers The huge drive to immunize the masses against threat of...

California Ends Anthem Rate Hike Battle

Michael Douglas, MD, MBA — Thu, 26 Aug 2010 13:11:23 +0000

For the past six months insurance regulators in California have been working through negotiations with Anthem, a BC insurer whose initial premium rate hikes became a cause célèbre for healthcare consumers in that state and the Obama administration, alike. The previously proposed 39% increases created a firestorm in healthcare policy circles and provided Obama and HHS a temporary PR headache as a solution to lower premium increases was sought. The end result after scrutiny of state ledgers is a “smaller” increase — of approx. 14 percent. | MP3 LINK

Sebelius, Obama Blast Wellpoint Insurance Subsidiary’s Decision to Hike Insurance Premiums If Obama ever wished he could tell Insurance to just...
Anthem BC & Parent Company Begin Legislative Testimonies Regarding Massive Rate Hikes Legislative grilling in California begins today for Anthem Blue Cross,...
Citing Insurers’ Rate Hikes, Obama Takes Message for Reform to Public Again Any momentum gained by President Obama when the issue of...

AARP: Vast Majority of Branded Drugs’ Prices Grew Faster Than Inflation in ’09

Michael Douglas, MD, MBA — Wed, 25 Aug 2010 19:53:29 +0000

The AARP today released a watchdog analysis (using Medicare claims data) depicting the general increase in the price of the most popular prescription medications relative to prevailing inflationary trends. And, surprise! The lobbying group notes an almost 10 percent increase in the price of branded preparations straight from the manufacturer for 2009. Apparently, all but 6 of the over 200 brands studied showed any increase over the rates of inflation for that period. Pharma is quick to dispute the group’s findings as they do not include more precise reporting of actual point of purchase data to the consumer, forgoing mentions of rebates and plan discounts. | PDF LINK of AARP’s report

Study: Generic Cardiovascular Drugs As Effective As Branded Ones Two-thousand eight has been dubbed the “year of the generic”...
Senator Touts Alliance by Pharma and AARP as Key Effort in Healthcare Reform The nation’s largest drug lobby, PhRMA, desperate to be included...
Study: Industry-Sponsored Research Yields Favorable Results a Majority of the Time Confirming what many, if not all providers in healthcare delivery...

MN Safety Net Mechanism Faces Unexpected Problems with Payment Formula

Michael Douglas, MD, MBA — Tue, 24 Aug 2010 12:57:02 +0000

The retooled GAMC health plan initiated due to the budget crisis in this state earlier this year appears to be at a crossroads of sorts — and it involves payments to the participating safety-net hospitals.

The discussions began because Hennepin County Medical Center (HCMC) in Minneapolis has had a smaller percentage of potential patients enroll than the other three participating hospitals and, as a result, is getting paid more than twice the amount per patient.

The capitated-type payments to the hospitals which have the resources to participate in the GAMC overhaul was introduced as a way to complement patient enrollment caps to each of those participating hospitals. However, it appears that there is a breakdown in access-to-care and cost-per-patient parity, with HCMC getting the lions’ share of patients outside of the scope of its available general assistance medical funds. | LINK

Minnesota Hospital May Be Ultimate Arbiter in State’s Ability to Provide Safety Net Care to Poor The state’s largest acute care medical safety net, Hennepin County...
Developing Story: Minnesota’s Largest Acute Care Safety Net Rejects Alternate State Proposal for Indigent Care The board of the state’s largest publicly funded acute care...
Hennepin Co. (MN) Med. Ctr. Agrees to Participation in Revamped Indigent Care Program The drama unfolding in the past week during which acute...