Cooperating for better care.

Robert Whitcomb

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Sector boosting recruitment of execs from high tech


The healthcare sector, including health insurers, is increasing recruiting from the high tech world for its executives, says a Med City News article. And it’s not just because of the proliferation of health high-tech startups.

To read more, please hit this link.

Investors in healthcare stocks unfazed by ACA drama


Despite Republican threats to destroy the Affordable Care Act, healthcare stocks  are generally doing very well and people in the sector generally don’t expect the GOP to make major changes in what turns out to be a remarkably sturdy ACA.

Bloomberg News reports:

“Healthcare companies in the Standard & Poor’s 500 Index have rallied 16 percent this year, beating the overall market’s 11 percent gain. Insurers, the companies tied most closely to the Affordable Care Act, are up even more at 22 percent.

“Wall Street’s apparent indifference to the possibility that Republicans will succeed in repealing the ACA shows how the for-profit health industry has largely separated itself from the law’s fate. ”

“’It’s really steady as she goes,’ said Les Funtleyder, a health investor at E Squared Capital Management. ‘Most of the stocks are basically calling the Congress’s bluff, in that really nothing material is going to happen.’’’

“Republicans appear to be scaling back their ambitions. One possible path forward is a ‘skinny repeal,’ ending just a handful of the law’s most controversial features. GOP senators would likely push to halt requirements for all people to have health insurance and for companies to provide health coverage for full-time workers. A repeal of the tax on medical devices might also be included. But the insurance subsidies and Medicaid expansion would remain.”

To read more, please hit this link.


Career steps for women physicians


Read and hear a text and video discussion by three leading female physicians on the best career steps  for young women doctors. Hit this link.

How to lead effective clinical teams

Kate Hilton, of the Institute for Healthcare Improvement, writing in FierceHealthcare’s Hospital Impact publication, reports on how to best to lead clinical teams in an essay headlined “How to lead teams with purpose”.

Among her observations:

“Healthcare providers are constantly trying to keep up with changes coming from all sides; policymakers, health system executives, and payers mandate new ways of working all the time. Often, executives and C-suite leaders ask teams to change direction without presenting a clear vision for what lies ahead. This never-ending struggle results in increasingly high levels of burnout among healthcare teams and team leaders.

“Taking a step back, we know that staff in the caring professions are intrinsically motivated to do better for the people they serve. But how can leaders unlock their overworked teams’ potential? By learning unique leadership skills that will allow them to capture the hearts and minds of the people around them. By leading and organizing for change.”

Among her recommendations:

  • “Tap into our own motivations for change. Sharing … personal experiences became a much more effective motivational tactic than relaying a new mandate from the C-suite.’’
  • “Grow our power through our relationships. In organizing, we don’t teach leaders to ask, ‘What is my issue?’ Instead, we encourage them to ask, ‘Who are my people?’ In other words, get to know your people, who they are, what they value, and what hidden assets they bring.’’
  • “Develop shared purpose. Once leaders have recruited a team, they should kick off their first meeting by co-producing a shared purpose statement. Clarifying the compelling and consequential nature of their work together transforms their own interests into a desire to serve the common good.’’
  • “Take action quickly to build momentum—and to learn.People are motivated by seeing results quickly. In quality improvement, this concept is captured in the Plan-Do-Study-Act cycle. ”

To read her essay, please hit this link.

An upbeat look at physician-owned practices


There are grounds for optimism about the future of physician-owned practices as seen in the AMA’s most recent Physician Practice Benchmark Survey, says Aledade co-founder and CEO Farzad Mostashari, M.D., in a post in Healthcare Dive. Among his remarks:

“First, probably the most interesting quantitative and qualitative points of the report came in a section on hospital ownership. In 2014, the survey found that about a third of physicians were either directly employed by a hospital or in a hospital-owned practice. In 2016, that share had not changed.”

“Not only had the proportion of physicians in hospital employment flatlined, but the rate at which hospitals were buying up practices had slowed. In 2014, 24.5% said that a hospital had purchased their practice in the past five years. In 2016, that dropped to 21%.”

“Hospital acquisitions have flatlined. Most physicians are working in small practices. Physician ownership is still the dominant model. And this is good news for our healthcare system’s movement to a value-based payment future.”

“Small, physician-owned practices offer more personalized care and are more responsive to patient needs. They have lower average costs per patient, fewer preventable hospital admissions, and lower readmission rates than large, hospital-owned practices. And primary care doctors can influence up to 85% of downstream costs in our nation’s healthcare system.”

“The simple fact is that the data from AMA shows that small, physician-owned practices are neither irrelevant nor are they going extinct. In fact, they’re in the best position for a new era of better healthcare at lower costs. ”

To read more, please hit this link.


Centene reports strong insurance-marketplace business


FierceHealthcare reports:

“Driven by a strong performance in its health insurance marketplace business, Centene reported better-than-expected second-quarter earnings on Tuesday—the same day Senate Republicans were poised to vote to advance legislation to repeal the Affordable Care Act.

“The insurer, which primarily specializes in Medicaid managed care, said its its profits rose to $254 million ($1.44 earnings per share) in the quarter, up from $171 million in the second quarter of 2016. Its adjusted EPS of $1.59 beat analysts’ consensus estimate of $1.30 per share, and it raised its full-year guidance by 18 cents to a range of $4.70 to $5.06 per share.

“Centene said its “strong 2017 marketplace performance” exceeded its expectations in the second quarter by $0.12 diluted earnings per share, and added that its second-quarter earnings of 17 cents per share net benefit related to risk adjustment under the ACA.

“The insurer previously said it would expand its ACA exchange presence in 2018, even as policy uncertainty has driven other insurers to exit.”

To read more, please hit this link.

Providers fiercely fight price transparency in Ohio


For Kaiser Health News


Two years after it passed unanimously in Ohio’s  Legislature, a law meant to inform patients what healthcare procedures will cost is in a state of suspended animation.

One of the most stringent in a group of similar state laws being proposed across the country, Ohio’s Healthcare Price Transparency Law stipulated that providers had to give patients a “good faith” estimate of what non-emergency services would cost individuals after insurance before they commenced treatment.

But the law didn’t go into force on Jan. 1 as scheduled. And its troubled odyssey illustrates the political and business forces opposing a common-sense but controversial solution to rein in high healthcare costs for patients: Let patients see prices.

Many patient advocates say such transparency would be helpful for patients, allowing them to shop around for some services to hold down out-of-pocket costs, as well as adjust their household budgets for upcoming health-related outlays at a time of high-deductible plans.

At the Ohio Statehouse, the law’s greatest champion in state government has been Rep. Jim Butler, a Republican and former Navy fighter pilot whose wife is a physician. He authored the legislation and has beat the drum for it since he got the idea in 2013, as he waited for a garage mechanic to repair his car and absorbed the shop’s posted rates for brake jobs, oil changes and tuneups.s).

Opposition has been formidable, led by the goliath Ohio Hospital Association. It has filed a court injunction that is currently delaying enactment, peppered local news media with editorials, and lobbied Republican Gov. John Kasich, who has eliminated funding that would allow implementation from the latest state budget.

Joining the hospital association in its legal action are a wide range of provider groups including the Ohio State Medical Association, the Ohio Psychological Association, the Ohio Physical Therapy Association, and the Ohio chapters of the American Academy of Pediatrics, the American College of Surgeons and the American Osteopathic Association.

These groups say that the law, which applies only to elective procedures, is too broad and that forcing providers to create estimates before procedures would slow down patient care. “The only way to even try to comply with the law is to delay care to patients in order to track down information from insurance companies, who may or may not provide the requested information,” wrote Mike Abrams, the president and CEO of the Ohio Hospital Association, in an op-ed in The Columbus Dispatch in January.

But Jerry Friedman, a retired health- policy adviser for the Ohio State University Wexner Medical Center, said the opposition doesn’t stem from genuine concern about patients but from a desire to keep the secret rates that providers have negotiated with insurers under wraps. Transparency would mean explaining to consumers why the hospital charged them $1,000 for a test, he said, adding that providers “don’t want to expose this house of cards they’ve built between hospital physician industry and the insurance industry.”

Said Butler on his quest to see the law enacted: “The healthcare industry has a lot of political power and lots of money. It’s hard to fight on behalf of people against this kind of force.”

The law’s next test will come in August, when the first court hearing on the association’s lawsuit is scheduled. The Kasich administration said it couldn’t comment on the law because of the pending litigation.

Greater price transparency has been a popular policy prescription for America’s high health costs, especially at a time when many patients have high-deductible insurance plans and face larger copayments. Upfront estimates exist in other countries, such as Australia and, for patients facing out-of-pocket expenses, in France.

In Massachusetts, patients can get an estimate within two days of admission if they ask for it. Nebraska requires hospitals and surgical centers to provide a list of the average charges for services. New Hampshire has a website where consumers can compare costs.

Hospitals and doctors often oppose such measures. The American Hospital Association’s position is that health plans — not hospitals — are responsible for telling insured patients about their out-of-pocket costs, according to its website.

Aimee Winteregg, 35, of Troy, Ohio, said she would have liked such information before five miscarriages in four years left her buried in unexpected medical bills. She and her husband became first-time parents in November. Though they are well insured, tests and treatment cost the couple $4,000 out-of-pocket, demanded in bills that were sometimes no more descriptive than for “medical service.”

“We don’t want to deal with this, especially when the doctor tells you stress is bad for the pregnancy,” her husband, J.D., said. But imposing greater transparency has been controversial in both the medical industry and among some health care researchers, who say it puts patients in an untenable position.

The transparency law “was written by someone thinking about health care as a TV, and not as health care,” said Sandra Tanenbaum, a professor of health services management and policy at The Ohio State University College of Public Health.

She said people could not shop for procedures as they would for a TV or car repairs, since they often lack information on the quality of doctors and hospitals, and make health care decisions based on much more than cost.

Consumers are more likely to base their decisions on their doctors’ advice, not on cost alone, according to a report from the Health Policy Institute of Ohio.

Only around 10 percent of health care costs are even “shoppable” expenses — procedures that can be scheduled in advance, like an MRI or elective surgery — according to the HPIO.

Regardless, Butler maintains, the health care industry can give consumers better information upfront. “If you really want patients to be empowered, they really need the information,” he said.

In support of such access, Butler has written letters to the Ohio Hospital Association, the Ohio attorney general and the Dayton Daily News, all in defense of the transparency law.

The Ohio Hospital Association, along with seven other Ohio health organizations, went to court last December to block the law, a month before it was supposed to take effect.

Butler said Gov. Kasich’s administration is helping the hospital association stall by not writing regulations, eliminating funding for the law in the state budget, and declining to meet with Butler to discuss it.

State Rep. Michael Henne, also a Republican, has worked with Butler in the Ohio General Assembly on the transparency law. He called Butler a “driver” on the law, noting: “It’s frustrating. You don’t realize how much [influence] special interests have in the process.”

Another sad tale of extreme profiteering in U.S. healthcare?

This is the sort of story that reminds Americans of just how profit-driven U.S. healthcare is and why it’s by far the most expensive in the world (but with mediocre outcomes compared to most Developed Nations). A  recent New York Times article begins:

“Early last year, executives at a small hospital an hour north of Spokane, Wash., started using a company called EmCare to staff and run their emergency room. The hospital had been struggling to find doctors to work in its E.R., and turning to EmCare  {part of publicly traded Envision Healthcare} was something hundreds of other hospitals across the country had done.

“That’s when the trouble began.

“Before EmCare, about 6 percent of patient visits in the hospital’s emergency room were billed for the most complex, expensive level of care. After EmCare arrived, nearly 28 percent got the highest-level billing code.

“On top of that, the hospital, Newport Hospital and Health Services, was getting calls from confused patients who had received surprisingly large bills from the emergency room doctors. Although the hospital had negotiated rates for its fees with many major health insurers, the EmCare physicians were not part of those networks and were sending high bills directly to the patients. For a patient needing care with the highest-level billing code, the hospital’s previous physicians had been charging $467; EmCare’s charged $1,649.”

To read The Time’s article, please hit this link.

Metrics to look for when choosing a hospital


recent study …suggests that there are some metrics that patients and their families should be aware of when choosing a hospital. The study, by health economists at MIT and Vanderbilt, found that hospitals that score better on certain metrics reduce mortality. Among the ones they examined were patient-satisfaction scores.

The article, by health economist Austin Frakt, said, among other things:

“In addition to testing the predictive ability of satisfaction scores, {the} study examined indicators of high-quality care — things that a hospital does that are believed to improve outcomes, like the rate at which a hospital gives heart attack patients aspirin upon arrival.

“Here, too, hospitals with better such indicators had lower mortality and readmission rates. The very best hospitals by these measures can reduce the odds of death within a year by 14 percent relative to the very worst hospitals, for example.”

To read The New York Times article on this, please hit this link.

Subsidies worsen healthcare ‘system’ dysfunction


Megan McArdle writes in Bloomberg View that taxing hospitals is a bad way to fix the U.S. healthcare mess. Among her observations:

“Obamacare was supposed to increase utilization of the health-care system — which means utilization of hospitals, and therefore, their profitability. It was supposed to reduce the number of people who had medical bills they couldn’t pay. If you supported Obamacare, this is good news for your position: It shows the law working roughly as it was supposed to. So what’s the issue?

“Well, many hospitals have non-profit status, which means they don’t pay taxes on their revenue. To keep that nonprofit status, they are supposed to provide community benefits. One of the major benefits they provided was health care for people without insurance. Now that fewer people are without insurance, there is a question about just what constitutes a community benefit that would justify leaving these hospitals untaxed.  National Nurses United, a union that the article cites repeatedly, would like that community benefit to be defined as providing charity care. Hospitals would like it defined as ‘Anything we want to call community benefit.”’

“The labor union seems to be seeking to turn this provision of the tax code into a jobs program for nurses, by mandating that non-profit hospitals spend a certain amount of their revenue on charity care, an activity which will, of course, require the employment of many nurses. The hospitals, meanwhile, are trying to avoid paying a large tax bill, while avoiding any government interference in their operations. Both sides have wrapped themselves in the banner of the public good, as special interests are apt to do while they are sliding their hands into the taxpayer’s pocket.

“Neither side is necessarily wrong: Sometimes lobbyists promote good ideas that just happen to make their clients some money. And I find it all too easy to believe that hospitals are benefitting from a nice tax subsidy while not really doing much worth subsidizing.

“But if that’s the case, then the best solution is probably to stop subsidizing it, not to make the subsidy more complex. A lot of the current mess in the American health-care system can be traced back to the thicket of hidden subsidies and fiddling regulations we’ve enacted over the years, trying to fine-tune the system into some platonic ideal where nothing ever goes wrong and no one ever makes an unseemly amount of money. But fine tuning has not delivered us the platonic ideal of anything, except perhaps the word ‘dysfunction.’ It might be time to step back and rethink our approach.”

To read m0re, please hit this link.

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