Legislative | Regulatory

Fee-For-Service is Pervasive yet Perverse

The FFS payment model was created long ago, during a time when physicians treated less-complex problems and offered only a few inexpensive therapeutic interventions. It worked back then but a significant percentage of patients today have multiple chronic conditions. Meanwhile, the number of complex and very expensive tests, medications and interventions available are practically unlimited.

Economics 101 teaches that as supply goes up, costs should come down. But this tenant doesn’t hold true in medical care – not when the supplier also controls demand.

In health care, doctors can stimulate demand because (a) health insurance blinds most patients to the costs of services and (b) patients often don’t know whether a complex procedure is as necessary as a non-invasive one.

As a result, we have seen a major increase in utilization of complex services over the past 20 years.

That’s a short extract from an important FORBES article, The High Cost Of American Health Care: You Asked For It. Everything in the article is consistent with my understanding of economics and long-held view that the problem with our healthcare system is perverse incentives in the payment model. I highly recommend it. Read the rest of this entry »

AT&T Teaches Seniors About Technology

I’m happy that AT&T is reaching out to teach seniors about technology, because so few of them understand or use it, and the problem is worse than we think. I’ll discuss that after the video.

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Regulations Not Keeping Up with Technology

Health ReformBy Wayne Caswell

The rapid and accelerating pace of tech innovation has profound implications for healthcare delivery & payment, aging, and disability employment, but regulations that support that are spotty or nonexistent.

The good news

“Durable medical equipment” is a class of assistive technology that can be paid for by Medicare, Medicaid and many private insurance plans. Motorized wheel chairs most often fall into this category. Read the rest of this entry »

The Patient-Centered Medical Home, an Interview

The PCMH and Home Care Data: An Interview with Melissa McCormack is a byline article by Melody Wilding

PCMH LogoThe Patient-Centered Medical Home (PCMH) Model is a new approach which seeks to enhance care coordination and community-based care.

To learn more about how health care data fits into the PCMH model and how the new approach will helps seniors, we spoke with PCMH specialist Melissa McCormack of Software Advice, a source for medical systems reviews.

How does home care fit into the PCMH model? 

The PCMH model is all about putting the patient at the center of care. Under traditional fee-for-service models, doctors have no incentive to follow their patient’s health outside of the office, because they receive no compensation for doing so. But the PCMH model rewards doctors for keeping their patients healthy, which incentivizes them to monitor their patients’ health not just in the office, but at home, too.

Read the rest of this entry »

Johnson & Johnson Fined, but Admits No Guilt

The Daily ShowComedian commentator Jon Stewart aired a segment about corporate malfeasance on The Daily Show last night and joked about the relative lack of accountability, comparing the Corporation to People but showing how people are punished much more severely. Besides several Wall Street examples, there was Johnson & Johnson. Read the rest of this entry »

Can Insurers Force Better Care at Lower Cost?

InsuranceFierceHealthPayer.com recently published an article that looked at successful strategies to improve health care and lower costs. It mentioned

  • bundled payments,
  • global payments, and
  • accountable care organizations.

But that’s as far as it went, so I added the following response to show other ways that the ACA and changes to the healthcare Payment system can disrupt the Deliver system. Read the rest of this entry »

Telehealth Enhancement Act takes Important Step

Telehealth KioskAs a member of the American Telehealth Association (Austin chapter), I too support the Telehealth Enhancement Act, however I see it as just a baby step and think much more is needed. Still, it’s a step in the right direction.

The proposed bill would modernize the Medicare program by allowing Medicare patients to be cared for remotely by a licensed healthcare provider from any state. That way, if you need medical help while on vacation, you could connect online or by phone with your own doctor back home without requiring that they be licensed in the state you traveled to. I urge Congress to adopt this bill and expand it beyond Medicare, to other federal agencies and health benefit programs.

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Opposition to Universal Health Care

Obamacare Protest SignWhat’s the REAL reason people oppose universal healthcare? The fear of helping “LOSERS”

That was the title of an article by MedCity News, and I couldn’t help but comment.

The article said FEAR was a dominant reason some Americans find it so hard to support universal healthcare. The dark side of this belief is that “Anyone who doesn’t work hard enough, or doesn’t have enough determination, is a Loser, and nobody wants to pay for free healthcare for those losers.”

It doesn’t seem to matter whether these ‘losers’ are old people or little kids or bankrupt people or people who’ve lost their job or people who have serious health problems through no fault of their own. People who are afraid of helping ‘losers’ talk about impeachment or defunding the government or killing Obamacare.  Read the rest of this entry »

FDA won’t regulate these mobile apps

FDA LogoThe FDA final guidance lists several types of apps that may meet the definition of a medical device, but that pose lower risk to the public and will not be regulated. That should free developers to innovate and allow useful consumer products to come to market more quickly while ensuring that the mobile health apps are not only convenient, but safe.

The following list of apps (from mobihealthnews) highlights the 21 types of apps that the FDA called out in their guidance, saying it “understands that there may be other unique and innovative mobile apps that may not be covered in this list that may also constitute healthcare related mobile apps.” The agency says this list is not assumed to be or meant to be exhaustive, but rather is intended to provide some clarity. Read the rest of this entry »

Why Health Care Costs are Obscenely Expensive (Infographic)

Health Care Spending

 

Americans spend more on health care
but live sicker and die younger. Why?

 

We’ve published dozens of articles addressing that issue and have accumulated thousands of statistics in hundreds of Infographics. But today we include an important infographic that combines 12 charts created by Jan Diehm for The Huffington Post. Afterwards is a video description, a counter-point argument, and my own view of how Obamacare will address some of the issues.

 

Read the rest of this entry »

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