Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog]Reform creates new incentives in health care

An aside…
Twice a week I volunteer at a soup kitchen/clothing distribution center. And three times a week I make phone calls screening folks for the Social Security Extra Help program which helps very low income people with their prescription drug costs.

English: U.S. Health Insurance Status (Under 65)

English: U.S. Health Insurance Status (Under 65) (Photo credit: Wikipedia)

Many folks are hard pressed to come up with $4.00 copays.
Reblog From the 24 July 2013 article at Kevin MD

 | POLICY | JULY 24, 2013

I advocated for the Affordable Care Act, and celebrated when it was passed.

It’s good to have everyone covered, I thought.

Insurance for everyone is the first step to health care for all.

Alas, access to health insurance isn’t the same as access to health care.

First there is the niggling detail of providers. We already have a primary care provider shortage.  Internists, pediatricians, family physicians are already working at full capacity in caring for the general health needs of a community. The poorest neighborhoods with the worse reimbursements already have a severe shortage of providers. More people with health care coverage, means more people will be seeking routine care, and we don’t have more providers ready to see them all.

For patients, this will mean longer waits to see a provider.  Or for providers, it will mean longer hours at work to see more patients.

Second, the ability to buy subsidized health insurance doesn’t automatically mean the ability to pay for health care.

I just learned that patients who are unable to pay their co-pays within 90 days may then need to face the entire medical bill on their own. How bad can a co-pay be, you may ask?

“When I say I have zero income, that means I have no money. None,” said one of my patients from the community health center where I work as a family physician on the South Side of Chicago, when I was encouraging him to buy generic medications at Walmart or Target. “$4 is too much for me,” he said.  “I’d need to steal to buy it. “

Zero income means an enormous challenge to pay anything, borrowing from a network of friends and relatives and searching out social programs for medical assistance. In some states, Medicaid will be expanded to cover everyone who is near the federal poverty line.  Other states are choosing not to expand coverage to young men.  Private insurance plans may effectively leave them unable to afford health care, even if they are able to afford subsidized health insurance on the state exchanges.

When patients who live on the financial edge, who currently don’t have health insurance miss their co-payments, they will become liable to pay the entire cost of the doctor’s visit.  After 90 days with no co-pay, then insurance companies would owe nothing.  The people who are poorest , who have the toughest time scraping together the money to cover their co-pays, may ultimately be responsible for paying not only their co-pay, but the entire medical bill, while also paying insurance premiums.

This would be unfortunate.

I wish we could turn back the clock and create a simpler system where everyone had access to care without needing to worry about who pays what.  Instead we have recreated pricing mechanisms that in effect result in tiered payments where the poorest patients continue to pay the most.

People are poised to buy into a broken system at the stroke of midnight announcing January 1, 2014.

The health insurance exchanges are coming—faciliating the buying and selling of imperfect products that promise access they can’t fully deliver, while potentially leaving vulnerable patients without full access to health care.

And still this is better than the alternative, where patients had no coverage at all, and the system wasn’t incentivized to find ways to become more efficient and more effective.

There will be new incentives in healthcare.  We’ll see what happens. The American healthcare system will need to continue to adjust to the needs of patients, to be responsive to the most vulnerable, in order to ensure a healthier America.

Kohar Jones is a family physician who blogs at Progress Notes.

  • The Math of State Medicaid Expansion (jflahiff.wordpress.com)
  • When considering health care costs, US physicians prioritize patients’ best interests (Medical News Today)
  • Viewpoints: Finding the benefits in reforming health care (sacbee.com)
  • Physician Skepticism About the Basic Doctrines of Health Care Reform: We’re In This Together and, by the way, More Believe In Care Management Than the EHR (diseasemanagementcareblog.blogspot.com)
  • Oregon medical community gears up for expansion (kansascity.com)
  • Cash-only doctors abandon the insurance system (money.cnn.com)
  • Railroading the health care law (kansascity.com)
  • My Family’s Obamacare (zocalopublicsquare.org)
  • Highmark forms alliance in bid to cut health costs (triblive.com)
  • Major Health Insurer Pulls Out of South Carolina, Two Other States, Because of ObamaCare (pjmedia.com)
  • Poll: only 11 percent of doctors think the ObamaCare exchanges will be ready (humanevents.com)
  • Views of US Physicians About Controlling Health Care Costs (Full Text Reports)
    July 24, 2013

    Views of US Physicians About Controlling Health Care Costs
    Source: Journal of the American Medical Association

    Importance
    Physicians’ views about health care costs are germane to pending policy reforms.

    Objective
    To assess physicians’ attitudes toward and perceived role in addressing health care costs.

    Design, Setting, and Participants
    A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile.

    Main Outcomes and Measures
    Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale.

    Results
    A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a “major responsibility” for reducing health care costs, whereas only 36% reported that practicing physicians have “major responsibility.” Most were “very enthusiastic” for “promoting continuity of care” (75%), “expanding access to quality and safety data” (51%), and “limiting access to expensive treatments with little net benefit” (51%) as a means of reducing health care costs. Few expressed enthusiasm for “eliminating fee-for-service payment models” (7%). Most physicians reported being “aware of the costs of the tests/treatments [they] recommend” (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they “should be solely devoted to individual patients’ best interests, even if that is expensive” (78%) and that “doctors need to take a more prominent role in limiting use of unnecessary tests” (89%). Most (85%) disagreed that they “should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more.” In multivariable logistic regression models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type was independently associated with enthusiasm for “eliminating fee for service” (salary plus bonus: odds ratio [OR], 3.3, 99% CI, 1.8-6.1; salary only: OR, 4.3, 99% CI, 2.2-8.5). In multivariable linear regression models, group or government practice setting (β = 0.87, 95% CI, 0.29 to 1.45, P = .004; and β = 0.99, 95% CI, 0.20 to 1.79, P = .01, respectively) and having a salary plus bonus compensation type (β = 0.82; 95% CI, 0.32 to 1.33; P = .002) were positively associated with cost-consciousness. Finding the “uncertainty involved in patient care disconcerting” was negatively associated with cost-consciousness (β = −1.95; 95% CI, −2.71 to −1.18; P < .001).

    Conclusion and Relevance
    In this survey about health care cost containment, US physicians reported having some responsibility to address health care costs in their practice and expressed general agreement about several quality initiatives to reduce cost but reported less enthusiasm for cost containment involving changes in payment models.

    The increasing cost of US health care strains the economy. Because physicians’ decisions play a key role in overall health care spending and quality, several recent initiatives have called on physicians to reduce waste and exercise wise stewardship of resources.1- 4 Given their roles, physicians’ perspectives on policies and strategies related to cost containment and their perceived responsibilities as stewards of health care resources in general are increasingly germane to recent pending and proposed policy reforms.5 We surveyed US physicians about their views on several potential proposed policies and strategies to contain health care spending, assessed physicians’ perceived roles and responsibilities in addressing health care costs, and ascertained physician characteristics associated with those views.

July 25, 2013 - Posted by | health care | , ,

No comments yet.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: