Here’s a developing Minnesota health policy item: governor lauds donation from major provider of indigent care to reduce state deficit — all the while, GOP lawmakers push for bill to make cuts to funds earmarked for the state’s Department of Human Services in an effort to reduce same budget deficit.
Democratic Gov. Mark Dayton announced the donation from UCare, which provides coverage for patients on state and federal programs including MinnesotaCare, Medicaid and Medicare.
While this move is a great one, I can’t help but anticipate what the GOP-led legislature has up its sleeve in creating cost-control measures for the critical delivery of care to Minnesota’s Medicaid and dually-eligible population of patients — given that cuts to institutionalized long term care and mental healthcare services are not on the table. | LINK
So-called austerity measures, a strategy in many Republican-dominated state legislatures to control spending, are getting increased attention nationally, spurred by the international news story that is Wisconsin’s budget battle. Within the scope of healthcare-related legislation, budget-specific priorities can come in many flavors. While modifying entitlements (like Medicaid) probably constitutes the best known example for balancing state budgets with respect to health policy, slashing funding for state-employed healthcare organizations and care delivery is increasingly being seen as an easy target for many state governments, many with the potential for significantly negative consequences.
Just over a month into the Medicare competitive bidding program, and patients, their advocates, economists, and just about anyone with a stake in the process has nothing good to say about it. The program, implemented by the government to cut Medicare costs and find the least expensive options for services (like DME), requires that a sealed bid, given to an issuer by an underwriter, come with a prospective price and terms for a contract. At the close date of bidding, the issuer picks the best offer. However, CMS has sharply restricted the numbers of suppliers which can take part in the competitive bidding process.
Patients are complaining that they are not receiving certain goods and services as prescribed by their providers. Poorer quality delivery of services by home care agencies, longer lengths of stays of beneficiaries in acute hospitals due to affected discharge planning, and fewer overall choices for patients for certain DME services — have all contributed to the angst surrounding this process. Critics do not seem to be blasting the process in a strict sense, but they’re concerned that the program’s design undermines transparency, subsists on inaccurate information supplied by Medicare, and increases the potential for fraud and abuse by third parties, as a result.
Overview of the Medicare competitive bidding program | LINK
American Association for Homecare concerns & resources for affected patients and other parties | LINK
Medicaid has long been regarded as Medicare’s (ugly) stepchild, primarily because of the essentially fifty different ways the program is sustained nationwide and the myriad federal ins-and-outs of a long complicated relationship with managed care and federal financing. Not surprisingly, many states are taking the opportunity exploit the concerns of very real budgetary deficits to propose streamlining plans to cut many of its services many lawmakers — both Republican and Democrat — say are wasteful.
A pretty interesting piece on the role some hospitals are playing in actively going after acute care costs. Focusing on the repeat patient whose social maladies complicate cost-effective chronic care measures with poorly handled acute care treatments — usually in the emergency department — the article notes a couple of enterprising physicians who are working with third parties outside of their overburdened health systems to meet the revolving-door patients head-on.
One of them is Brenner, the Camden doctor who subsequently started the Camden Coalition, with the help of some funds from the Robert Wood Johnson Foundation, to hire nurses and social workers to manage patients in their homes and keep them out of the hospital.
The other is Rushika Fernandopulle, a Harvard-educated internist in Atlantic City, who runs a labor union clinic with a dedicated focus just on 1,200 employees of the casino and the hospital, AtlantiCare Medical Center, that rack up the most medical bills.
Dr. Brenner’s program, sort of a mobile medical home, was able to achieve a near 40 percent reduction in ED visits for acute “exacerbations” of social program/community program lapses. Pretty cool — hospitals’ efforts to go beyond merely hiring ancillaries to provide sound patient follow up after discharge are admirable lessons for controlling acute care costs…even if forced to make such decisions in trying economic times. | LINK
President Obama’s push for the digitization of the medical (health) record continues its march toward the goal of complete adoption nationwide by mid-decade. The administration’s desire for this goal as a part of reform is as much a laudable task as it is a daunting one. Cost of complete market saturation among healthcare facilities and systems is one issue. The other? Some providers in more rural and urban areas where care is provided are concerned that EHR adoption will not immediately benefit healthcare delivery to the economically disenfranchised.
Call it the “digital divide” as it relates to the electronic record. Sure, cost of adoption is one thing — but the realization that private and government initiatives over the next four or so years will continue to favor larger systems with heftier resources is quite apparent. To be fair, the feds have allocated some $300M in stimulus funds for this problem. But, just how far will funds go not only to ensure access for the poor and uninsured in economically deprived care environments but also to begin to reverse the all too familiar correlation between poorer health outcomes and lower income levels among patients? | LINK
UPDATE & RELATED: A graphic shows the penetration of EMR adoption by state (criterion: any EMR component use as defined by the CDC in 2010). Happy to see Minnesota at the top of that list! | LINK [PDF]
Physicians employed at a previously public-run NYC hospital affiliated with Columbia University narrowly avoided a strike by ratifying a new contract to continue providing healthcare services there. At issue was the possible truncation and loss of some pension benefits and tuition reimbursements for employed physicians and family members, as the hospital was run by the city. The city’s public charter ended this year as it begins to explore ways of utilizing private contracts to provide physician services.
Approximately a whopping 75 percent of unionized physicians there voted to strike, if necessary. The move for NYC to turn to private agencies to staff the hospital (joining other city hospitals) is just another sign of the troubled current healthcare delivery system and the costs that can be incurred by municipally-owned acute hospitals as they struggle to save money under the spirit of reform. Apparently, NYC’s fiduciary relationship with Harlem Hospital spanned some 40 years prior to this painful, but apparently necessary, transition. | LINK
A new way for some to curb the addiction to smoking — electronic cigarettes — is not only gaining popularity among those who use them, but the product is also adding fresh controversy to the debate over the marketing of tobacco and what really constitutes appropriate use of nicotine replacement products as an ostensible way to kick the habit.
An appeals court ruling yesterday decided that the e-cig products should be treated like true tobacco-containing products with respect to oversight by the FDA. What this means is that these products are not seen as therapeutic, in the strictest sense, and must be treated as a drug.
This ruling is exclusive of the e-cig’s increased popularity, a characteristic of the product that some see as a potential slippery slope to unregulated marketing practices to certain vulnerable populations — like children and teenagers. Until under the control of the FDA, the sky’s the limit for promotion of these products, with any hope for rigorous study on their purported benefits dashed for now. | 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.
Mobile healthcare innovations are the way of the future! #mhealth Check out this article published by Forbes: http://t.co/rqIO0Gj5
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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.
