He notes such developments as “new Tufts Health Plan partnership with Lifespan to offer a tiered network health plan, known as Lifespan Premier Choice, beginning July 1, where the lowest-priced tier would all be providers within the Lifespan hospital system.”
And “CharterCARE Health Partners, the for-profit joint venture with California-based Prospect Medical Holdings and anchored by Roger Williams Medical Center and Our Lady of Fatima Hospital, is apparently recruiting physician groups in Rhode Island to join in a similar kind of narrow care network….”
Mr. Asinof notes that “the larger question, yet unanswered, pertains to how ‘health’ is defined within the healthcare delivery system and a continuum of care. Is health the absence of sickness as defined by the need for care? Is health defined by social and economic determinants beyond the measurement of the healthcare delivery system?
“As insurers become linked to hospital systems, and as hospital systems become their own insurance networks, and as the risk in the market is redefined as a doctor’s responsibility, how does the consumer play? What is the patient’s voice – other than to fill out a patient satisfaction survey? How do nurses – who hold up more than half the healthcare delivery system – get to play and be rewarded in the new value-based care reward system?”
“So why would CIOs claim to ‘own’ patient engagement? Maybe they are simply clueless about what patient engagement really involves. CIOs rarely interact with patients. Most CIOs have no direct healthcare experience, and are not trained as doctors or nurses. For example, a recent list of “100 Hospital and Health System CIOs to Know” included only 10 with health professional degrees (seven M.D.’s, three R.N.’s).
”Why then, not simply admit that the issue is out of their area of expertise, rather than claiming ‘ownership.’ My best guess is this is the bravado, or arrogance of generic managers.”
“The law signed by President Barack Obama includes a waiver that, starting in 2017, would let states take federal dollars now invested in the overhaul and use them to redesign their own healthcare systems.
“States could not repeal some things, such as the requirement that insurance companies cover people with health problems. But they could replace the law’s unpopular mandate that virtually everyone in the country has health insurance, provided the alternative worked reasonably well.”
Of course, many of these young people have other health problems related to their mental illnesses, such as substance abuse. We wonder how many of these young people frequently present at the state’s Federally Qualified Health Centers.
The New Haven Register reported: “The data show five hospitals had increases of more than 12 percent in the number of days that patients with behavioral health problems were hospitalized. The biggest increases were at Yale-New Haven Hospital, which saw the number of patients rise 61 percent, and inpatient days jump 51 percent; and Waterbury Hospital, with 26 percent more patients and a 37 percent increase in inpatient days. The increase at Yale-New Haven is partly due to its merger with the Hospital of St. Raphael in 2012.”
The steps include identifying a target amount per physician, installing process-improvement initiatives and providing performance incentives.
It notes that ”physician compensation rates are increasing while reimbursement rates are declining. These trends threaten the financial solvency of healthcare organizations and, as a result, hospital boards and leadership teams are tending more critically to the financial performance of their physician enterprises.”
“Investors are putting faith in the idea that the market is headed toward shared-savings payment models. They’re placing their bets to get in on the ground floor,” the publication reports.
“The long-term opportunity for private-equity firms is the ability to sell these managed-care-savvy medical groups to insurers or health systems, which may pay a premium for the care-coordination expertise and data analytics these practices offer.”
“Still, many systems have yet to see a return on their investment in buying physician practices. Employing physicians means they need to pay hefty salaries and benefits, as well as the overhead costs associated with office-based practices. ”
“Hospital consolidation, done properly in a competitive marketplace, can have positive effects. Multi-hospital conglomerates can quickly disseminate best practices and quality initiatives, for example. But competition and the choices it provides can also disappear.”
“Today’s frenzy of hospital mergers and physician practice acquisitions is giving hospital systems even greater leverage to inflate opaque ‘charge-master’ medical bills that even hospitals are sometimes unable to itemize sensibly. With no mechanism to allow free-market forces to keep prices in check, this translates into higher health-insurance deductibles and copays for insured Americans, and in the case of Medicare and Medicaid, higher taxes.”
Dr. Malary, a surgeon at Johns Hopkins Hospital, gives examples from around America.
Further, he writes: “As a busy surgeon, I have serious concerns about the race to consolidate America’s hospitals because of the risk that very large organizations may govern without valuing the wisdom of their front-line employees.”
A 1936-38 Works Progress Administration poster.
They wrote that the cardiothoracic surgeon”has manifested an egregious lack of integrity by promoting quack treatments and cures in the interest of personal financial gain,” the Associated Press reported, and that he has “misled and endangered” the public.
The 10 doctors asserted that “Dr. Oz has repeatedly shown disdain for science and for evidence-based medicine, pushing, for instance, “miracle” weight-loss supplements with no scientific proof that they work.
