Insurance|Medicare|Medicaid

Meaning And Depth of the Primary Care Crisis

photo image of Stephen C. Schimpff, MDThis is Part 1 of a Series on The Crisis in Primary Care by Stephen C Schimpff, MD

The primary care physician (PCP) should be the backbone of the American healthcare system. But primary care is in crisis – a very serious crisis.

The first statement is my considered opinion and I will attempt to convince you of its truth. The second sentence is a simple fact.

Accounting for only 5% of all health care expenses, the PCP can largely control the “if and when” of the other 95% and hence can be the one to best affect quality of care and the totality of costs. This crisis limits the effectiveness of the primary care physician such that care quality is nowhere near what it could be or should be and the costs of care have skyrocketed. Read the rest of this entry »

Medical Tourism is a Growing Trend

Medical TourismToday’s short post features my response to a Forbes article by Dr. Robert Pearl, Offshoring American Health Care: Higher Quality At Lower Costs?, about the Cayman Islands, which are known for inviting coral-sand beaches, laid-back island culture and tax-free status.

Medical Tourism is a growing trend

This trend is not just in the Cayman Islands. Over 8 million people worldwide, and 1.3 million Americans, cross international borders for better and cheaper care. That trend will increase as insurers offer low-cost policies with high deductibles that encourage consumers to seek the best value in health care and lifestyle decisions. Read the rest of this entry »

Early-Stage Obamacare – How’s it Going?

Is your glass Half Empty, or Half Ful?EDITOR: Opinions of Obamacare, and whether it’s a glass half empty or half full, depend largely on one’s political viewpoint and sources of your information. Opponents of the law, including many in the medical industrial complex with lots to lose if health reform cuts costs, often cite articles hinting that it’s a failure, while proponents cite articles highlighting successes and progress. The mainstream media, in efforts to generate buzz and attention, seem to stoke the fires of controversy by avoiding the hard task of investigative journalism and simply publishing inflammatory stories fed to them by either political party without checking the facts. Then again, the official government numbers, which you can believe or not based on your politics, present a moving target. So, I’m more interested in the trends and the long-term implications and publish today’s byline article with some editorial comments added.

Early-Stage Obamacare:
A Checkup on the Health of the Affordable Care Act Thus Far

By Paisley Hansen

What will be the ultimate impact–for good or bad–of the Affordable Care Act on Americans? Although it’s still too early to tell, a January 13 article by the Associated Press posted on AOL sheds some light on the health status of Obamacare thus far [2.2M through December, 2013]. Read the rest of this entry »

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 »

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 »

Saving while Helping your Kids & Parents

Click to view original photo

Flickr photo credit: geoffreyrockwell

By Lucy Stewart, a financial counselor
for families looking to get out of debt

Forty-eight percent of middle-age adults provided support to their adult children in 2012, which is up from 42 percent in 2005, according to PewSocialTrends.org. Also up is the financial support they provide their aging parents: 21 percent said they provided some financial support to a parent age 65 or older in 2012, up from 19 percent seven years earlier.

Offering financial support to your adult children and 65+ parents does not mean that you give up your own financial plans and dreams. Family is family, but sacrificing your personal well-being won’t benefit anyone. Look for ways to cut expenses and create streams of income, and don’t assume you have to do this alone. 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.

Read the rest of this entry »

The Forgotten Civil Right – Healthcare

MLK - I have a dreamIn honor of the 50th anniversary of the March on Washington and Dr. Martin Luther King Jr.’s ”I Have a Dream” speech, Dan Munro wrote a wonderful column on Forbes reminding us that King saw healthcare as a civil right. Sadly, we have made little progress on healthcare inequality, with roughly 50 million Americans without health insurance and another 40 million under-insured.

The Affordable Care Act (Obamacare) is poised to relieve some of that, with the individual mandate to buy healthcare insurance and subsidies for low-income Americans. But individual states are still allowed to choose whether or not to support and fund a key component of the ACA – Medicaid expansion. Many will, but some won’t.

Many doctors have walked away from taking Medicaid patients, and some have abandoned Medicare patients too. Read the rest of this entry »

Elders Get a CAPABLE Hand in Shoring Up Home Safety

Jack and Jill, a Mother Goose nursery rhyme

Jack and Jill went up the hill
To fetch a pail of water.
Jack fell down and broke his crown,
And Jill came tumbling after.

CAPABLE, which stands for Community Aging in Place, Advancing Better Living for Elders, is a Baltimore-based project that helps low-income older adults “age in place” with assistance from occupational therapists, nurses and handymen.

The project is being closely watched by Medicaid officials in other states as a way to coordinate care, improve personal function, and avoid pricey and sometimes preventable nursing home admissions. Today, it’s difficult for Medicaid patients to get these services.

With more than $8 million in research money from the National Institutes of Health and the Centers for Medicare and Medicaid Services, the project goes beyond home repair for health. It starts with a full-scale assessment of each participant’s needs.  Read the rest of this entry »

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