by George Chapman, GW Chapman Consulting

VA privatization?  Recent problems within the VA healthcare system have prompted a special VA commission to consider allowing vets to receive their care at private facilities while the VA begins to close their own hospitals beginning with the obsolete and little used.  Several veteran’s groups have expressed opposition to the proposal saying their opinions/feelings have neither been considered nor solicited.  The VA operates 150 medical centers and 1,400 outpatient clinics, employs 53,000 licensed professional and cares for 8.3 million vets.

Cyber-attacks.  The hacking of healthcare data is becoming more frequent and sophisticated. Most of the attacks come from Russia, China and eastern Europe. Hackers are looking for protected health information and medical technology intellectual property to sell on the black market. “Ransomware” is designed to destroy backup files and databases unless the victim pays a ransom to have their data unlocked. The FBI is encouraging victims NOT to pay the ransom as to do so would only encourage the hackers. The defenses against these attacks are costing the healthcare industry billions.

MD assisted suicide.  California is moving towards legalizing physician assisted suicide for the terminally ill. It’s already legal in Washington, Montana and Vermont. Of course, the eventuality of California entering the market has prompted the manufacturer of Seconal, developed over 80 years ago, to gouge the public. In 2009, a lethal dose of Seconal costs about $200. Valeant Pharmaceuticals has raised the price to $3,000.

NYS mergers driving up prices.  A study by the conservative think tank, the Manhattan Institute, concludes that the 100+ hospital mergers in NYS have served to only increase costs and decrease competition with no perceptible increase in quality. The Institute recommends greater price transparency among hospitals and to establish a commission mandated to monitor healthcare consolidation and costs. Mergers that result inI price increases would be subject to antitrust litigation. Accounting firm PWC agrees. According to their market analysis which included 5,600 hospitals, bigger hospitals have obvious economies of scale advantages over small hospitals; but it doesn’t carry over (so far) when these hospitals merge.  Hospital mergers have not resulted in noteworthy cost savings or improved quality.

Employer sponsored insurance.  Many thought the ACA would cause a decline in business sponsored health insurance.  According to the Congressional Budget Office, 57% of Americans, about 155 million, will still get insurance through their employer this year.  The CBO predicts this will drop slightly to 152 million in three years, but then remain stable through 2026.  The main reason for this stability is probably employees have come to expect coverage through their employer.

Controlling drug prices.  In an effort to control spiraling drug prices, Medicare is trialing a new payment model whereby physicians who prescribe drugs that are cheaper but equally effective as the higher priced options will be rewarded. The thought is to have both the physician and patient do the math. Physicians are still free to  prescribe the most expensive drug if they truly believe it is in their patient’s best interest.

Good Samaritans.  A survey of North Carolina physicians revealed that 93% took action in a medical emergency outside of their office.  The most common place for emergency services was on an airplane.

War on cancer.  This is one war we are actually winning. Cancer related deaths have decreased from 215 per 100,000 deaths in 1990 to 166 per 100,000 deaths in 2012. That is a 23% decrease in just 22 years. Cancer mortality has dropped across the board for all cancers. Since 1990:

breast -36%,

prostate -50%,

colorectal -39%,

non-Hodgkin’s lymphoma -28%,

ovarian -22%,

cervical -34%,

leukemia -15%,

lung -24%,

kidney -12%,

liver -70%,

oral -29%,

pancreatic -3%,

stomach -47%,

thyroid -25%,

brain -10%.

NYS #21. The annual United Health survey of states ranks #1 Vermont as the “healthiest” and #50 Louisiana as the “sickest”. The study considers factors like diet, smoking, alcohol intake and obesity in its  ranking.      

Measuring and reporting “quality” is expensive.  Your physician spends about $40,000 a year in staff time and money just to measure their progress against several quality measures imposed by Medicare and commercial payers. Many are calling into question the return on investment when it comes to value based payment.  What it costs a physician to comply and report almost negates any increased payment or rewards for meeting quality metrics. While measuring and rewarding quality is a laudable goal, the inefficiency in collecting and reporting the data clearly contributes to the negative attitude in the medical profession towards the whole concept.

April awareness month.  Alcohol abuse, autism, child abuse, distracted driving, minority health, world health and air quality.


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