A look back at the week's health policy news with a
focus on ACA implementation
Only two issues of this blog to come after this one, so
treasure these while you can. I’m still figuring out what’s next after the blog
ends, so stay tuned.
You might have heard a little something about another ACA
case headed to the Supreme Court regarding the subsidies. With oral arguments scheduled
for next Wed (3/4), media coverage is increasing (to put it mildly), we’ll take
a look. Also this week new numbers regarding the rate of uninsured, finalized
open-enrollment figures, new CMS rules on a variety of subjects, ACA tax
implications past and present, a Republican proposal to sort-of extend CHIP, and
as always, much more.
Some of these topics were addressed in the weekend update
posted Sunday. For those who’ve read that, I’ve indented the repeated sections
so you can skip past.
ACA: Court Cases
There has been so much coverage of the case this week that even
I haven’t read it all. But I’ve read a
lot of it so you don’t have to. This week I’ve divided this section into four
parts: Primers, Legal Discussion, Impacts, and Politics.
Primers
For those who haven’t focused on the case until now, Kaiser
has provided a primer (Are
Premium Subsidies Available in States with a Federally-run Marketplace? A Guide
to the Supreme Court Argument in King v. Burwell), and the Penn Institute
of Health Economics has provided a syllabus (King
v. Burwell 101 - Required Reading) to bring you up to speed.
Legal discussion
For those interest in the legal arguments, four pieces for
your intellectual stimulation:
Chief
justice could again swing Obamacare case in government's favor “But in
several key cases in recent years Roberts has voted in ways that could favor
the government's arguments. He has raised concerns about upsetting the balance
between federal and state law, particularly when there is ambiguity in a law's
wording. He has also recognized the need to consider the overall context of a
law, not just an isolated phrase.”
Fifty
Shades of Wrong “Just in time for oral argument, Tim Jost and James
Engstrand have a new article out on King v. Burwell. In it, they march through
the statute identifying anomalies—at least fifty of them—that accepting the
plaintiffs’ interpretation would create.”
Health
Law Challenge Tests Supreme Court’s Firmness on Right to Sue “But it is not
clear that the Supreme Court will address that question, which could determine
the outcome of the case. The court’s recent decisions have been inconsistent
and provide few clues about what it might do. The court is sometimes accused of
being opportunistic in using the standing doctrine to avoid legal questions it
wants to duck, but ignoring the issue when it is eager to weigh in.”
The
conservative ruling that might save Obamacare “Today, defenders of the
health law, including many states, are themselves citing Pennhurst. They say
the Affordable Care Act provided no clear notice to states that if they did not
set up their own insurance marketplaces under the law, their residents would be
barred from getting federal insurance subsidies.”
Impact
What happens if the SCOTUS finds for the plaintiffs (that
subsidies cannot be provided through healthcare.gov)?
Secretary Burwell announced that in fact, there is nothing
the Administration can do if that comes to pass and so has no contingency
plans: Health
Secretary Says There’s No Backup Plan if Supreme Court Rules Against Law “The
new message is consistent with her previous stance, but considerably more
alarmist in tone. The letter describes the consequences of a court ruling for
the case’s plaintiffs: the loss of insurance subsidies for millions of people
in a majority of the states, followed by increases in the number of uninsured
Americans and instability in insurance markets.”
Some were skeptical of her statement: HHS
Secretary Questioned on Health-Law Contingency Plans “During a
congressional budget hearing with HHS Secretary Sylvia Mathews Burwell, Rep.
Joe Pitts (R., Pa.), chairman of the Energy and Commerce Committee’s health
panel, said a source had confirmed HHS has a roughly 100-page planning document
that relates to potential actions. ”This is a document I’m not aware of,” Ms.
Burwell testified. She said she would like to know about the document if it
exists.”
It is the height of irony that the people who support the
case to strike down the subsidies, are now complaining that the administration
won’t (can’t) do anything about it.
As we’ve discussed in the past, a ruling against the
subsidies will have far reaching impacts.
One area is premiums. Such a ruling would make existing
premiums insufficient to cover claims, so Health
insurance actuaries want leeway to change rates if Supreme Court kills
subsidies “Health insurance actuaries are pushing HHS to allow plans to
revise their rates for 2016 coverage if the U.S. Supreme Court invalidates the
Affordable Care Act's premium subsidies in federally run exchanges. They warn
that without leeway to adjust premiums in health plans sold in those
marketplaces, the solvency of some insurers “could be threatened.””
Kaiser takes an in-depth look at the impact on the insurance
markets: Insurance
Markets in a Post-King World. I can sum it up for you with three words:
premium death spiral. But one important point to remember is that all health
care is local, while the insurance markets in states denied the subsidies may
collapse, those where subsidies are still available will be for the most part
unaffected – more about this dichotomy below.
Of course the impact on individuals’ care will be the
greatest tragedy of an adverse ruling: The
Supreme Court's Obamacare decision will determine if this cancer patient gets
chemotherapy. Getting back to the different impact on different states, note
the maps in the article showing what states will be impacted. An adverse ruling
would result in our country having some states where the insurance markets will
continue to function and some states not so much. Note that it is the poorest
states that will be without, and whose federal taxes will be subsidizing those
states that continue to have subsidies available.
And the impact goes even further: Morning
Plum: A Court decision gutting ACA could be a lot worse than you think “Green
talks to health care policy and industry experts and concludes a ruling against
the law could “hurl the political system, and no small part of the economy,
into chaos.””
With all that in mind, there are some who think that while
initially an adverse ruling will cause problems, in the long run states will
have no choice but to create exchanges, even if it takes a few years (echoes of
the Medicaid argument): Why
the New Lawsuit Won’t Kill Obamacare “It is true that, if successful, the
lawsuit would pose a huge humanitarian setback to the sick and poor. But in the
long run, its impact on the law would probably disappear. And in the short run,
it threatens Obamacare’s opponents, not its advocates.”
Politics
As mentioned above, all health care is local, so what will
the states do? “POLITICO interviewed more than a dozen governors, from both
parties, this weekend at the National Governors Association winter meeting.
Most said they’re in a wait-and-see zone.” (What
if the Supreme Court rules against Obamacare?)
On a national level, as much as opponents of the law may be
hoping for a decision for the plaintiffs, it may very well be a case of the dog
catching the car: If
SCOTUS kills Obamacare subsidies, Republicans don’t have an exit strategy. This
piece reviews options for Republicans if SCOTUS finds against the subsidies.
And while there is no doubt there will be a human tragedy in
lost care and coverage, an adverse ruling could change the political landscape:
Supreme
Court ruling could upturn Obamacare politics “But if the subsidies go, Democrats
could run ads attacking the Republicans for trying to take away coverage from
their own newly insured constituents. They could feature a heart patient who
has to skip his next echocardiogram, a pregnant woman who loses her coverage
and is cut off before her baby is born, a breast cancer patient, like Barbara
Fox, worried about paying for her next round of chemo.”
Next week we’ll have coverage of the oral arguments, but as
we wait for the avalanche of analysis sure to follow, remember that in many
cases, the oral arguments do not yield meaningful information on how the case will
eventually be decided. For that we’ll have to wait for the decision sometime in
June.
ACA: Uninsured Rates
Gallup came out with its final estimates of the rate of
uninsured for 2014 and the results were impressive: Survey:
Uninsured rate hit new low in 2014 “The share of Americans without health
insurance dropped to its lowest level in seven years in 2014 as President
Barack Obama's overhaul took full effect, according to an extensive survey
released Tuesday. The Gallup-Healthways Well-Being Index found that the trend
appears likely to continue this year, since 55 percent of those who remained
uninsured told the pollster they plan to get coverage rather than face
escalating tax penalties.”
The national results show a split between states that have
expanded Medicaid showing a greater increase than those that did not expand. Locally,
Maine’s
uninsured rate dropped in first year of Affordable Care Act, poll shows “The
number of uninsured among Maine’s roughly 1.1 million adults declined from 16.1
percent in 2013 to 11.6 percent in 2014, the national polling firm said.” Of
course the number would have been even better if we had expanded Medicaid here.
ACA: Enrollment
To see the full impact of the ACA, here are Obamacare’s
32 million insured, in one giant chart “"Now that every state (except
for Idaho) has been updated through at least February 15th," he wrote,
"here, once again, is the complete 2015 ACA enrollment graph, showing the
rough breakout of all 32.3 million people whose current healthcare coverage is
either wholly or partly due specifically to the Affordable Care Act."”
The only conclusion you can draw is For
Tens of Millions, Obamacare Is Working “Now statistics for the second year
are largely in hand and the verdict is indisputable: Its disastrous 2013 rollout
notwithstanding, the Affordable Care Act has achieved nearly all of its
ambitious goals.”
One of the questions of this second open enrollment was how
would the reenrollment process play out. Would consumers return to the
marketplace in the second year to check their plans? I admit that I was pessimistic. I’ve never
been so happy to be wrong – we now know that Obamacare
Users Turn Out To Be Pretty Good Shoppers “Of the 4.2 million people who
were returning customers, about half let themselves be automatically
re-enrolled with the same plan. The rest came back to HealthCare.gov and
contemplated their options, with roughly equal numbers selecting new plans or
sticking with what they had before.”
Primary Sources: Open
Enrollment 2015 Re-Enrollment Snapshot and Open
Enrollment Week 14: February 16, 2015 – February 22, 2015.
Here in Maine we learned that Lewiston
health insurer again woos most of Maine Obamacare enrollees “With several
days left for consumers to pay for March 1 coverage, Lewis expects that MCHO
will ultimately be responsible for about 80 percent of the marketplace. Last
year, MCHO had about 83 percent of the marketplace.”
As this year’s open enrollment drew to a close, CMS released
rules for the next one. Much of this was covered in the weekend update,
repeated here for your convenience - remember, indented means it’s from the
weekend update, normal margin means new content)
New rules for 2016 open
enrollment and plans
While 2015 open enrollment
completed, it’s not too soon to be thinking about 2016. In a series of
announcements, CMS released final details on many provisions: Press
release: CMS issues the final HHS Notice of Benefit and Payment Parameters for
2016 and Final
HHS Notice of Benefit and Payment Parameters for 2016 (CMS Fact Sheet)
Tim Jost has released four pieces
on the rules:
Here are some of what I consider
the most significant announcements:
- The rule finalizes the annual open enrollment period for 2016 to begin on November 1, 2015 and run through January 31, 2016. Note this is a change from what was previously planned.
- Network directories must be up-to-date, accurate, plan specific and complete (including if the provider is accepting new patients). Issuers also must make this information available in standard, machine-readable formats accessible without creating an account.
- Formularies most also be posted and accessible without an account, also machine readable.
- Machine readable means that third party vendors will be able to produce decision support tools to assist with the process.
- Auto reenrollment stays the same as this year – they will not change as originally proposed to account for lower cost plans. Individuals will be reenrolled in their same plan regardless of changes in premium.
- CMS intends to continue to use the state EHB benchmark approach through at least plan year 2017 rather than define EHB itself.
- Plans are warned against back-door discrimination such as what happened in FL where certain plans put all HIV drugs in a specialty tier thereby discouraging enrollment of those who needed the drugs.
- Changes to the definition of essential community providers (those interested in details should read the second Tim Jost link above).
- Some changes to special enrollment rules, including allowing special enrollment period if income increases over 100% FPL threshold making them eligible for APTCs.
(New:)
- Clarifying regulations on risk programs (reinsurance, risk adjustment, risk corridor) – no material changes
- Slight changes to rate review, threshold remains at 10% increase but now at plan instead of product level of analysis
- Minor SHOP adjustments and clarifications
- Beginning in 2016 for the 2017 plan year, insurers must submit a Quality Improvement Strategy as required by the ACA but which until now there have been no final rules.
- Note that the Letter to Issuers restates for the insurers items states in the Benefits and Payment Rule.
ACA: Taxes
How good a job did people do estimating their income? As people start to complete their taxes,
those receiving subsidies are reconciling those estimates with their actual
income in order to calculate final subsidy amounts. H&R Block has some data
for us: Turns out 52% of their customers reconciling subsidies will owe some
money back, on average reducing their tax refund by 17% (or $530). At the same
time about a third will get additional subsidies as part of their refund, on
average about $365. Primary Source: H&R
Block: Taxpayers Following ACA Rules, Refunds Take a Hit
And from Friday, news of a special enrollment period and the
mailing of some incorrect tax forms. Much of this was also covered in the
weekend update, repeated here for your convenience - remember, indented means
it’s from the weekend update, normal margin means new content)
Special enrollment period for tax
filers subject to penalty
In perhaps the least surprising
announcement ever, CMS announced there will be a special enrollment period from
March 15 to April 30 for those who find out they have to pay a penalty (shared
responsibility payment) for not being covered in 2014 and are not enrolled in a
plan for 2015.
More details are in the press
release: Press
release: CMS Announces Special Enrollment Period for Tax Season
And the NY Times reviews the
situation: A
Second Chance to Avoid a Second Tax Penalty Over Obamacare “The
department’s decision reflects two realities: 1) Confusion about how Obamacare
works remains very high. Several surveys have shown that many of the uninsured
don’t understand that there are deadlines for coverage, penalties for failing
to get insurance, or financial assistance that might make insurance affordable.
2) There’s a basic mismatch between enrollment season and tax season that
interferes with the incentive structure of the law. The punishment for not
being insured last year comes too late to sign up for this year. That means
that without the special period, many people would have been doomed to pay two
years’ worth of penalties.”
800,000 Incorrect Tax forms
mailed
In a goof that does not help us
make the argument that government programs can run efficiently, HHS announced
they sent out 800,000 incorrect forms. These were forms 1095-A which are needed
to allow individuals to calculate the actual APTCs (advanced premium tax
credits) they are entitled to as opposed to the amount estimated during
enrollment. Some of these forms contain the wrong benchmark premium, an amount
needed to correctly calculate the appropriate APTC.
You can read details here: The
government sent 800,000 Obamacare enrollees inaccurate tax forms “Approximately
800,000 people who bought coverage through Healthcare.gov received inaccurate
tax filing documents, federal officials said Friday. These forms had the wrong
price for the local "benchmark plan:" an important number that the
government uses to calculate every Obamacare enrollee's subsidy.”
And the NY Times provides this
helpful FAQ: What
to Do if You Got the Wrong Tax Forms
A few days after reporting the error, the Treasury
Issues Reprieve for Health Law Tax Errors “The decision amounts to a
reprieve from paperwork headaches for an estimated 50,000 early filers, out of
a pool of some 800,000 HealthCare.gov customers affected by a tax reporting
goof disclosed last week.”
ACA: Other
We’ve talked about the continuing affordability issues. With
that in mind, some positive data with respect to affordability under the ACA: Medical
debt woes decline for families eligible for insurance subsidies “According
to the results of the a survey by the Centers for Disease Control and
Prevention, 28% of Americans younger than age 65 in near-poor families (those
with incomes between 100% and 200% of federal poverty thresholds) reported
their family struggled to pay medical bills during the prior year. That's down
from 32.9% of those surveyed throughout 2013.”
Another critique of ACA compliant plans is the prevalence of
narrow networks. There is broad agreement that while they may be a viable
option, “Greater transparency about health plans' provider networks is needed
to help consumers understand which doctors and hospitals they can go to without
incurring very high out-of-pocket costs, experts agreed at a forum Tuesday
sponsored by the Federal Trade Commission.” (Experts
wrestle with narrow-network issues at forum on competition)
And finally, a reminder that 2018 is just around the corner as
IRS
considers exclusions on 'Cadillac' health plans. The tax won’t be assessed
until 2018 but conversations are starting on the details of how it will be
implemented.
Costs
Two interesting pieces from Vox about the next focus for
health care reform: After
Obamacare: The next Democratic health agenda and Democrats
have the wrong idea for their next health care agenda.
While both present interesting information, a couple of
observations: The ACA has a large focus on cost and quality, so it’s unfair to
say those are next when they are already ongoing. Also, when people talk about
the problems we have here in the US re cost, they often combine two distinct
situations. First, we have a price problem, this is what sets us apart from
other countries and why we spend so much more as a percent of GDP. Second, we
have a value problem, we provide unnecessary treatment and sometimes incorrect
treatment; that is a problem all countries are grappling with. Payment reform can
address one, the other or both but we must be clear that they are distinct
issues.
Along those lines, If
fee-for-service is a problem, what's the solution? “The fee-for-service
payment model for healthcare treatment may be withering, but there's little
hard evidence that alternative payment models such as accountable care
organizations will provide better care at a cheaper cost, experts agreed in a
forum Wednesday convened by the Federal Trade Commission.”
Separate but related to how we pay providers is how we
design health benefits. Here is a wonky but fascinating look at Innovations
in health insurance design “Recently, there has been much discussion of
innovations in benefit design, including on this blog, where there was a recent
post about a split benefit design. Given the range of proposed options it is
useful to revisit the connection between benefit design and theory.”
On a (potentially) more practical note, a new website
populated with insurance costs has been launched: Major
insurers are finally revealing one of health-care’s greatest mysteries “Anyone
can use the site without charge to get a better idea of the baseline prices for
health-care services in their area, based on the actual prices that these
insurers pay to providers. Guroo's data won't tell the whole story for patient
costs, though. The site doesn't break down what a consumer pays for services
versus what the insurer pays. It's better to think of the price platform as
more of a guide, Newman said.”
Medicaid
As you may have noticed in the enrollment section above,
Medicaid enrollment is an important part of increasing access under the ACA. New
numbers this week show Nearly
10.8 Million Additional Individuals Enrolled in Medicaid as of December 2014
“The Medicaid and CHIP data being release today shows enrollment reaching
nearly 10.8 million additional individuals as of December 2014. This represents
an 18.6 percent increase over the average monthly enrollment for July through
September of 2013, the pre-Marketplace open enrollment timeframe.”
The ever-changing fate of Utah’s Medicaid expansion has
changed again, this time maybe for the last time: Governor's
(Utah) Medicaid expansion plan may have hit dead end “Hours after the Republican
governor's plan earned key approval in the state Senate, Republican House
Speaker Greg Hughes said Wednesday afternoon that the GOP-dominated House will
not consider the governor's plan because it has no support.”
States
Increase Pressure on Congress to Renew CHIP Funding “The NGA (National
Governors Association) notes “CHIP is widely supported by governors, who
recognize that access to health insurance is critical to ensuring a healthy
start for our nation’s children.” The letter refers to the 42 governors who
responded to Congress with overwhelming support for the extension of CHIP. (The
eight that have not responded are FL, LA, ME, MO, MS, MT, NE, and NJ.)”
But while that letter was being received, Republicans
Introduce Discussion Draft of Plan to Extend (S)CHIP Funding – And There is
Much to Discuss… The proposal is not the clean extension the Dems had proposed.
Here is a more detailed look at the problems with the proposal: Hatch-Upton CHIP
Proposal Moves Backward on Children’s Health Coverage “Unlike legislation
from Senator Sherrod Brown (S. 522) and Representative Gene Green (H.R. 919),
however, which would provide federal CHIP funding for the next four years and
largely continue existing policies, the Hatch-Upton draft proposes a series of
major changes to CHIP that would likely cause substantial numbers of low- and
moderate-income children on CHIP today to become uninsured or to lose access to
needed care.”
Medicare
Data out this week on the savings resulting from the closing
of the donut hole: Since 2010, 9.4
million people with Medicare have saved over $15 billion on prescription drugs
“Since the enactment of the Affordable Care Act, 9.4 million seniors and people
with disabilities have saved over $15 billion on prescription drugs, an average
of $1,598 per beneficiary. In 2014 alone, nearly 5.1 million seniors and people
with disabilities saved $4.8 billion or an average of $941 per beneficiary.
These figures are higher than in 2013, when 4.3 million saved $3.9 billion, for
an average of $911 per beneficiary.”
And from Friday, announcements regarding proposed Medicare
Advantage rates and new nursing home ratings. Much of this was covered in the
weekend update, repeated here for your convenience - remember, indented means
it’s from the weekend update, normal margin means new content)
Medicare announcements
CMS announced proposed payment
factors for 2016 Medicare Advantage and Part D plans: Press
release: CMS proposes 2016 payment and policy updates for Medicare Health and
Drug Plans
Most significantly is the proposed
Medicare Advantage rate increase. However, what was released is far from final:
“The CMS has proposed increasing health insurers' Medicare Advantage payment
rates by 1.05% for 2016, a move that kicks off a 45-day dogfight in Washington
before the rates are cemented. The base rate was a 0.95% average decrease, but
"when combined with expected growth in plan risk scores due to
coding," Advantage plans will actually receive the 1.05% hike in revenue
next year, according to a release from the CMS posted late Friday afternoon.” (CMS
pitches 1.1% boost to Medicare Advantage payments)
A significant element in how
Medicare Advantage plan rates are set is the risk score assigned to the plan.
We covered last week how suspect these scores are. Here is a piece published
before the new rates were announced reviewing the topic: Reducing
Medicare Advantage Overpayments “Upcoding is a long-standing problem in
Medicare Advantage, as CBO and the Government Accountability Office (GAO) have
documented. According to MedPAC, risk scores were 8 percent higher in Medicare
Advantage, on average, than in traditional Medicare for comparable
beneficiaries. And MedPAC analysts noted that the amount of upcoding seems to
be getting larger.”
The issue of provider lists is not limited to ACA plans,
Medicare Advantage plan lists have also been suspect leading to: Medicare
may penalize Advantage plans for faulty provider lists “The agency is also
stepping up audits of Medicare Advantage plans this year. Companies that “fail
to maintain complete and accurate directories” or do not have an adequate
network of providers accepting new patients could be fined through civil money
penalties. In rare instances, the CMS could slap plans with an enrollment
sanction, which some in the industry have called a kiss of death.”
And finally, on Friday CMS also
announced a change in the way Nursing Home ratings are assigned: Press
release: CMS Strengthens Five Star Quality Rating System for Nursing Homes.
“The star ratings of nearly a third
of the nation’s nursing homes were lowered on Friday, as federal officials
readjusted quality standards in the face of criticism that the ratings were
inaccurate and artificially inflated.” (Medicare
Toughens Standards on Nursing Homes)
Drugs
In the cost section above I talked about how prices are
higher in this country than elsewhere, that discrepancy lead to Maine being the
first state to allow drug imports. That law was just nullified as Judge
overturns Maine law allowing prescription drug imports “A federal judge has
overturned Maine’s first-in-the-nation law allowing residents to purchase
medication by mail from other countries. … Federal law strictly limits the
importing of prescription drugs from foreign countries for personal use.
Torresen ruled that Maine infringed on the federal government’s established
regulatory authority by allowing drug importation at the state level. Her
decision nullifies the law, pending a potential appeal by the state.” I can’t
argue the merits of the case, but I can argue the FDA needs to change the
Federal regulations if that’s the only way to allow cross boarder shopping.
Sometimes people think I’m too hard on pharmaceutical firms.
To those people I offer these three items to justify my hostility.
Item one: Gilead
Avoids Billions in U.S. Taxes on Its $1,000-a-Pill Drug. “The company
reported foreign income before taxes of $8.2 billion for 2014, earning more in non-U.S. profits than it
recorded in non-U.S. sales (emphasis added). The data released in a
securities filing Wednesday suggest that Gilead is taking advantage of U.S.
rules that let companies shift valuable intellectual property to low-tax
countries, said Robert Willens, an independent tax consultant based in New
York.”
Item two: Shire,
Maker of Binge-Eating Drug Vyvanse, First Marketed the Disease Drug Company
promotes rare condition, then markets cure – which turns out to be a dangerous
amphetamine with addiction risks. I'm all for patient education, but when the
educator makes a profit from a specific solution, it makes the education
questionable. These techniques sweep many people up for treatment who don't
need it - plus in this case, the treatment (amphetamines!) is questionable.
Item three: The
Need For Publicly Funded Trials To Get Unbiased Comparative Effectiveness Data
“When the newer, higher-dose drugs are tested against the older, lower-dose
drugs, the trials are intended to show that the newer, higher dose drugs are
superior to the older drugs that will soon be available as a biosimilar or
generic. It can be very difficult to tell whether the results of such trials
reflect the differences between the active ingredients or simply the difference
in doses, but such trials are almost certain to lead to increased use of the
newer, higher-priced drugs.”
System Transformation
An important reminder: Let’s
break the association of palliative care as hospice. As important as
palliative care can be at the end-of-life, it is as important in other situations
where pain is affecting quality of life. Palliative care does not mean there is
no acute care, often they go hand in hand yielding a better outcome.
But eventually the end comes, and we as a society still don’t
know how to deal with it: Everything
I know about a good death I learned from my cat “And this is where I feel I
have been better served by my vet than many patients are by their doctors: we
have had, for the last two years, a continuous conversation about Dottie’s
end-of-life plan. No one has ever promised me a cure, or made me hope Dottie
will beat cancer. I have not been shuttled from one expensive treatment to the
next, in the hopes of another month or two. Some of this, doubtless, has to do
with cost — I am paying for all her treatments, so my vet has to run through an
itemized list of what she plans to do for Dottie so I can okay it. That also
means that we talk about the risks and benefits of her treatments in great detail,
so I can decide how best to treat her.”
Because we rely on science, we understand that as our
knowledge base increases, some things we previously thought were correct may
turn out to have been wrong. Two examples this week, a change in dietary
guidelines: Behind
New Dietary Guidelines, Better Science “I’m pretty immersed in the medical
literature, and all of this is still shocking to me. It’s hard to overestimate
the effect of the dietary guidelines. Hundreds of millions of people changed
their diets based on these recommendations. They consumed less fat, they
avoided cholesterol and they reduced their intake of salt.”
And important information regarding the epidemic of peanut
allergies: By
shielding infants from stuff, we may be making allergies worse “In other
words, exposing kids to peanuts, even those with a sensitivity, led to fewer
allergies. Conversely, not exposing them led to more allergies. I mean, kids
with a previous sensitivity to peanuts who were exposed to them had a lower
prevalence of peanut allergies at 5 years of age than kids who didn’t have a
previous sensitivity to peanuts, but were never exposed to them.”
On the technology front, Kaiser
tests video visits to cut waits. Unlike a video doctor’s visit from a stand-alone
ap on your phone, this is being used as part of an integrated system: “Truong
thinks care coordination is the key differentiator between Kaiser's video visit
model and the models used by companies that focus on providing telehealth
services. What those companies offer “is not comprehensive,” he said. “They go
by whatever medical history you've got. They can't book follow-up care, labs or
radiology.””
While Kaiser’s modest goal is to cut wait times, in
Mississippi it is to provide access to vital services and save lives: Mississippi
emerges as leader in telemedicine “The Center for Telehealth now includes
35 specialties. It provides 8,000 telemedicine visits a month and 100,000 a
year across the state, with services as varied as diabetes counseling and
robots examining premature babies.”
And finally for this week, a look at the importance of customer
service as the health care system continues to change around us: A
tale of two strep throats: Retail clinic vs. PCP “I will, on the other
hand, probably go look for a retail clinic next time I’m acutely ill and think
I might have a treatable infection. I haven’t yet decided just how much a day
of health is worth to me, but it’s surely more than the cost of a retail clinic
visit minus my $20 copay.”
All
comments and suggestions are welcome; please let me know what you think. And as
always, thanks for reading!
Funded by support from
the Maine Health Access Foundation
*The title is a tribute to the BBC show, the NBC show and the amazing Tom Lehrer album "That Was The Year That Was"
