Could retail be the solution to comprehensive healthcare delivery? Well, if big-box retailer Walmart has anything to say about it — then, bring it on! Stretching the idea of retail minute clinics to extremely absurd heights, the retailer wants to partner with other entities to increase care access ahead of the tsunami of increased coverage sure to occur once reform kicks in a couple of years from now. It lays out its plans in a 14-page Request for Information [PDF].
In-store medical clinics, such as those offered by Walmart and other retailers, could also be players in another effort in the health law: encouraging collaborations of doctors and hospitals who want to win financial rewards for streamlining care and lowering costs. Such collaborations, known as “accountable care organizations,” might contract with in-store medical clinics, says Paul Howard, a senior fellow with the Manhattan Institute for Policy Research.
The other entities, sometimes labeled as “vendors” in Walmart’s RFI, appear to be (healthcare) organizations which have the potential to collaborate on best practices for many chronic conditions — enabling the partner vendor to benefit in terms of quality, accountability, delivery of healthcare services in order to maximize their bottom lines.
This mode of healthcare delivery raises concerns, to be sure. Could we be seeing an entirely new way of the delivery of healthcare as a pure commodity to be negotiated and priced like any other product? Will it encourage other major national retailers to follow suit? What will this do to the traditional model of healthcare organizational delivery of primary care? Will it enhance it? Will it make it more accountable to third parties? How will this model benefit insurance companies’ approach to premiums in an altered delivery marketplace? Quite an interesting development in the ongoing saga of the cost of healthcare in this country. | LINK
The reining in of costs associated with spiraling Medicare coverage amidst the proposed so-called “doc-fixes” addressing incessant threats of congressionally mandated cuts has many on the Hill wondering what will the Super Committee do to remedy the situation? FYI, the Super Committee is the bipartisan congressional panel made up of 6 Dems and 6 GOPers tasked with putting the brakes on deficit spending to the tune of $1.5T over the next ten years. Issues of Medicaid and Medicare spending are high on the panel’s agenda.
Specifically, futher tightening of Medicare eligibility rules and block-grant funding of Medicaid are mong the most rancorous of discussions — so much so, that at least one Republican moderate senator has chosen to distance herself from the Super Committee recommendations forthcoming. Sen Olympia Snowe (R-ME) also cites her support of branded pharma rebates (something her GOP colleagues really aren’t enthusiastic about) as another mechanism to trim costs.
The ramped-up schedule endorsed by the panel has states, insurance companies, and policywatchers of reform on the edge of their collective seats as issues of funding of the Medicare hospice benefit funding and possible elimination of the SGR formula for determining Medicare reimbursements to phsyicians and hospitals are discussed along with Medicaid funding. | LINK
How does obtaining health coverage (insurance) compare to not getting it at all? According to a trial published via the National Bureau of Economic Research (Harvard/MIT), beneficiaries’ quality of life was enhanced and made a “big difference” in those patients’ self-health perceptions and their daily outlook — according to the study’s lead author. A quick glance at the results confirms that all encompassing statement, especially since the study employed the diagnostic “gold standard” in trial research by utilizing a randomized, controlled design.
Taking a look at approximately the first year of coverage for Medicaid beneficiaries in the state of Orgeon, the study showed that healthcare expenditures for those who got coverage increased by almost $800/year. Those who received Medicaid were around 60 percent more likely to get mammograms. Medicaid recipients were over 50 percent more likely to have a regular primary-care doctor. They were also in better shape financially and less likely to have unpaid medical bills. Those who got Medicaid were also far more likely to report themselves in good or excellent health. ED admissions did not decrease; however, the increase in ED utilization by beneficiaries was not statistically significant.
It is clear from the results that coverage, in and of itself, has a positive effect on patients’ perceptions of health and wellness. What is not documented as much at this time is how this translates into outcomes with respect to various chronic problems such as obesity, diabetes, and risk factors (such as serum cholesterol, blood pressure, etc.) for heart disease. Also, it is unclear how these results translate into real numbers once reform increases Medicaid rolls substantially by 2014. Researchers plan on following the participants for at least another year. | LINK
There seems to be a neverending chorus on how Medicaid, as a payment system, fails on so many levels. Administrative hassles for short term gain multiplied many times during the average workweek for primary care physicians mired in all of the paperwork, all with no end in sight — unless the provider wishes to end the relationship, of course. Some states have made working with Medicaid beneficiaries more problematic, by lowering matching funding of the program on many levels. It seems like practically every state in the nation, except here in Minnesota, has taken a route in cutting their respective HHS budgets as a primary strategy to meet budgetary shortfalls head-on en route to a balanced result.
To curb rising Medicaid costs, about a dozen states are starting a new budget year by reducing payments to doctors, hospitals and other health care providers that treat the poor. Some health care experts say the cuts, most of which went into effect July 1 or will later this month, could add to a shortage of physicians and other providers participating in Medicaid.
With government projections of huge increases in Medicaid rolls by mid decade on the cusp of reform, insurers, policymakers, lawmakers, and healthcare systems are faced with the reality that numbers of beneficiaries will continue to add to the cost of care delivery in spite of reform. With the federal government planning to supplement spending to offset some of those costs, sky’s the limit on the share the feds will pay — increasing GOP fears of even more spending. With states’ assistance from stimulus (approx $100B) funds practically gone, it’s no surprise that of the 49 states with a budget, around half of those have met the deadline with Medicaid cuts to providers. HHS budgetary issues are on the table in Minnesota today as part of our state’s effort to balance the budget and end its government shutdown.
Consider this: With a rate approaching 30 percent, the state of Texas has the highest degree of uninsured in the country. Now consider this: It has always been known in healthcare policy circles that, if given the chance, conservative lawmakers in the state would choose to opt out of Medicaid because of what they see as a wild “unsustainability” in the federal-state program for the short term.
One of the state’s lawmakers, a Senate republican, is introducing a bill whose end result would create administrative partnerships (as presumptive methods to control healthcare costs) among health systems — a compact — that would allow the state opt-out as a feasible way of reining in the cost of healthcare delivery to the poor and uninsured in Texas. The price tag: almost half a billion dollars. While consolidating administrative redundancies to reduce costs, the bill would also have some undesirable provisions, according to healthcare advocates for Texas’s poor:
This law is more designed to set up the legal structures that will allow doctors and clinics and labs and hospitals and health plans to work together to restructure themselves in a way that they can share information and savings if they really not just keep costs down but actually improve people health outcomes. [...] The bill allows Texas to ask the federal government for permission to take its share of funding and join other states in creating a compact, a healthcare program free of federal requirements.
It’s obvious that a federal opt-out is an impossiblity in the Obama administration, but it does open up the possibility for upping the ante in the reform debate via the anti-spending advocacy of the state’s current governor — who just happens to be considering seriously a run for the White House in 2012. | LINK
The AMA’s annual policy meeting is happening this week at its headquarters in Chicago. The organization, which is meeting this week to debate policy points including whether to refine its stance on the individual mandate provision of the reform law, disclosed membership numbers yesterday. Citing a loss of approximately 12000 physician members last year, the org says that its controversial support of the reform law in its complete form, didn’t help matters much.
An uptick in rolls in state medical societies and other national professional societies, perhaps in part over some members’ ideological differences over the past few years with the AMA, was also a factor. The voices of physicians opposed to the AMA’s current stance on the individual mandate continue to grow in volume as some groups are calling for alternatives to ensure access and “innovation” of quality healthcare delivery via the use of tax credits and other “noncompulsory” methods of patient incentivization as part of care access. The vote on the mandate is expected on Wednesday this week. | LINK
Originating from Saint Paul, Minnesota, [doctorpundit.com] is a weblog about the policy of healthcare and where it intersects with politics and public opinion; it is edited by Michael Douglas, MD, MBA. Welcome, and please consider my take on what is Healthcare 2.0, complemented by a few of my thoughts on my personal avocations and guilty pleasures: music, prose, and writing. Follow Doctor Pundit via RSS above.
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DOCTOR PUNDIT @ ONE YEAR | An occasional DP series from 2010 highlighting healthcare policy trends over the period from 2009-2010 in a compare/contrast format.
