Chris Fleming hosts the latest edition of Health Wonk Review, a compendium of recent posts on health care blogs.
On Managed Care Matters, Joe Paduda offers 5 predictions for health care in 2013. He’s convinced that all but a handful of states will expand Medicaid. (“The pressure from hospitals and providers will be overwhelming.”) He also predicts that “The feds and CMS will get even more aggressive on Medicare and Medicaid fraud.” (For what it’s worth, I think he’s right on both counts.)
Food for Thought
Some posts are likely to stir controversy, either because they’re rebutting the conventional wisdom, or because they’re questioning some deeply held beliefs. I think these posts are important because they define issues that we should all think about.
Over at Colorado Health Insurance Insider, Louise Norris examines the question of whether smokers should pay more for their health insurance. Under the ACA, smokers can be charged up to 50 percent more than nonsmokers. . . .
“Norris prefers the carrot over the stick,” Fleming observes, “endorsing the requirement that all plans cover tobacco cessation programs as part of the ACA’s preventive services mandate, although she cites evidence showing that implementation of this requirement has been inconsistent. “ (It’s worth noting that tobacco cessation programs work. “Sticks,” behavioral psychologists tell us, just aren’t nearly as effective.)
At the Innovative Health Media Blog David Wilson writes: “The Medicare Annual Wellness Visit (AWV) is the perfect vehicle to address the increasing need for early detection of cognitive impairment. The AWV” gives physicians the opportunity “to provide such a screening and receive reimbursement for it .
“Once a patient shows the need for additional testing physicians can use self-administered computerized tests to perform the additional screening without referring the patients to another doctor or office,” he adds. ” This also creates additional reimbursement for physicians.”
MM–I can’t help but ask: “Since we have no cure or effective treatments for Alzheimer’s (or most forms of senile dementia) do you really want to know that, in three or four years, you may be diagnosed with full-blown Alzheimer’s?”
Certainly, seniors who want this testing should have access to it. Perhaps, one day, accumulated data will help researchers understand the disease. But Medicare patients should know that they can say “No” There is no requirement that this be part of your Annual Wellness visit.
On the Health Business Blog, another David Wilson has published a post that is likely to be even more controversial. He argues that “The Nursing Shortage is a Myth.”
We have plenty of nurses, Wilson suggests. In fact, in the future, he writes, “robots will be replacing nurses “just as robots have replaced “paralegals” and “actuaries.” (“Insurance companies used to hire tons of them, but their work can be done much more efficiently with computers.”)
Over at Wright on Health, Brad Wright takes a look at the recent Institute of Medicine report comparing health in the U.S. to health in other wealthy nations. He notes that data on preventable deaths among young people points to the importance of public health interventions, including reducing access to guns.
Health Care Spending
In the last two weeks a number of healthcare wonkers have focused on health care expenditures,, including Adam Fein (who looks at spending on prescription drugs) and Jaan Sidorov, who questions claims by Richard Kronick and Rosa Po at HHS that the Affordable Care Act deserves credit for Medicare per-beneficiary spending growth of only 0.4 percent in 2012.
(Fleming notes “When the first sentence of Jaan’s post contained the words ‘North Korea,’ I had a sense this wasn’t going to end well for the ACA.”)
Over at Health Care Renewal Roy Poses suggests that one reason health care costs so much is because the policy community politely refrains from talking about widespread unethical behavior in our money-driven health care industry.
Writing on Health Affairs, Arthur Kellermann and David Auerbach focus on the impact of health care costs on consumers from 1999 to 2011, observing that “if health care costs over this 12-year interval had kept pace with the growth of other consumer prices” a typical middle-class “family would have had an extra $6,000 to direct towards other priorities in 2011 alone. Imagine what that might have meant to them, to millions of middle-class families like them.” /\
Exactly. The pain is becoming too great—and this makes regulation and legislation that reins in prices inevitable.
On the Health Care Economist, Jason Shafrin offers the good news: Over the past 3 years, health care inflation has slowed significantly. Will the trend continue ?
John Goodman doesn’t think so. On his Health Policy Blog, he expresses skepticism that reform initiatives such as medical homes, coordinating care and practicing evidence-based medicine will reduce the cost of health care. /
(Though one would think that coordinating care and paying attention to medical evidence when practicing medicine would improve the quality of care. And long-term, that should mean fewer hospitalizations –and lower costs.)
The Health Access Blog’s Anthony Wright is more optimistic.He believes that, after making some tough cuts, California is now in a position to leverage federal funding not just to expand Medicaid, but to improve it along with the entire state health infrastructure. California has been in the vanguard of health care reform, and I have long thought that Governor Jerry Brown (who understood that “less is more” long before most Americans) may well turn California into an “Accountable Care State.”
Workers’ Comp Insider’s Jon Coppelman points out that our century-old workers’ comp system is not designed to handle the increasing numbers of older workers in the modern workforce. He offers a compelling case study.