Archive for the ‘Uncategorized’ Category

Change in all its forms is one of the most important causes of individual stress. Health care providers are under pressure from all sides to change the way care is financed and delivered. The effect of these changes on individuals as consumers and patients is not yet clear, but what is clear is there are going to be significant changes in how individuals access and receive care. While the Affordable Care Act (ACA) will certainly affect an individual’s care most people will see these changes even if ACA were to disappear.

Changing consumer behavior is and has been the goal of almost everybody in health care. Individual behavior affects the incidence of disease while their behavior as consumers and patients affects the efficacy and efficiency of care. Changing provider payment mechanisms from fee-for-service to any of the many pay-for-performance reimbursement schemes is often justified as a means to give provider incentives to provide cost-effective care, but often the …

Continue reading Consumers In For a Wild Ride and They Might Be Driving »

An alarming stat came out this week: 42% of the population will be obese in 2030, rising from 32% today. And the costs associated with treating those people will exceed $550 billion over the next two decades. The report was presented this week at a conference sponsored by the CDC, titled “Weight of the Nation,” in Washington D.C., as well as published in the American Journal for Preventive Medicine.

If there was ever any question about the problem of obesity and the troublesome ripple effect it triggers on the body and our healthcare system, then this glaringly stark reality should surely settle the debate. We are a nation of fatties. Harsh, yes, but true. And we are in denial.

There are many reasons “why” but one is certainly the problem of awareness, rather lack thereof. And by “awareness” I mean two different types: 1) Consumers simply not knowing they are obese or the ramifications of obesity, either because of their socioeconomic conditions, location, …

Continue reading Bigger Not Better: America’s Obesity Epidemic a Stark Reality »

Earlier this week there was an article in North Carolina about a patient who was unemployed and had mounting medical bills that the hospital allegedly would not negotiate a discount or payment plan. The hospital is a non-profit tax-exempt organization as permitted under the Internal Revenue Code Section 501(c)(3). Therefore, the hospital is not required to pay taxes. However, the hospital must provide services to the community to support its charitable purposes. Over the last several years there has been an increased scrutiny on tax exempt hospitals to determine whether the facility is acting “for profit” or if it is in fact satisfying the charitable objectives and purposes which afford it the tax exemption. In fact, several hospitals lost their tax exempt status as a result of this increased scrutiny.

In order to address the tax exempt objectives of ensuring hospitals provide care to all patients and meet the needs of the community, the Patient Protection and …

Continue reading Community Needs Assessment and Its Implications »

Reading the transcripts of the arguments before the Supreme Court around the Affordable Care Act’s individual mandate to purchase health insurance gave me the same feeling I got when reading the Game of Thrones. For readers who may be unfamiliar with the book or the HBO series, Game of Thrones is a fantasy loosely based on medieval England and the world around England at that time, but with fire breathing dragons and zombies.  The discussion before and with the Supreme Court Justices seemed loosely based on the Affordable Care Act and the health care delivery system, but the discussion contained a couple of zombies and a least one dragon.

There are three fundamental issues that the discussion with the court danced around but only occasionally enunciated. First, the only mechanism for privately financing health care is health insurance.  Private savings are simply inadequate to cover costs of episodes of care for even moderately severe conditions. The only alternative to a …

Continue reading The Supreme Court Dancing with Dragons »

In all the coverage of the Healthcare showdown at the US Supreme Court, I have found one topic particularly interesting. It is the idea that the individual mandate may not be as new and renegade as one might think. There are in fact arguably many other individual mandates to which the US population is already subjected without much protest. One of which has to do with government subsidized health insurance! The next time you take a look at your paycheck stub make sure you pay special attention to the deduction for Medicare tax withheld.

That’s right, even if you don’t purchase health insurance for yourself, you are still paying monthly for a Medicare recipient’s health insurance. Therefore, why is it so unconscionable that you would be asked by the government to pay for your own insurance or pay a fine? One reason is the method in which Congress choose to achieve each. Medicare is a withheld tax, much like other mandated programs such as Social Security. …

Continue reading Is the Individual Mandate really a new idea? »

Healthcare took center stage again last week as the Obama administration’s healthcare law endured three days of questioning from the Supreme Court to determine if the insurance requirement mandate is unconstitutional. If so, it potentially puts the entire bill at risk. The healthcare industry, along with consumers, will watch closely as the June decision will have lasting implications on our future. But, regardless of your political persuasion, or opinion of Obama care, there is no doubt that the debate has forced an even bigger spotlight on our broken healthcare system.

Healthcare is personal. It’s one of the few political issues that go to the heart—quite literally—of Americans, not to mention their wallets. So it’s no surprise that people are passionate and vocal about it. And that’s a good thing. Impassioned people can make great change. We live in an age of the “empowered consumer.” These consumers, armed with knowledge, and powered by the latest …

Continue reading Healthcare Gets Front-Page News… Again »

I had the uncomfortable experience of having a statement I generally agreed with evaluated by Politifact Georgia. (link below)  The statement made by State Senator Judson Hill as that a “one percent increase in the cost of health insurance today causes about 30,000 Georgians to be uninsured.” When I was called by Politifact about that statement I responded with the appropriate caveats about the difficulty in arriving at that precise relationship given all the confounding factors determining health insurance coverage but that “If someone put a gun to my head, I’d say he’s pretty close.” Politifact went ahead and rated Sen. Hill’s (and by extension my) statement as “mostly false”.

It does not require a sophisticated economic analysis to see that the basic relationship is true: cost increases lead to fewer people with coverage. Politifact argued that the Senator Hill’s stated magnitude of the effect was too large. They cited some national studies and then …

Continue reading Health Care Costs and The Uninsured »

Joining the ranks of 25 other states (including Montana, Texas, Louisiana, and Florida), Georgia has yet to setup an online insurance marketplace for small businesses and uninsured individuals.  The Affordable Care Act (“Act”), passed in 2010, requires that health insurance exchanges be operational in the states by 2014.  Governor Deal’s spokesman cited the uncertainty over the fate of the Act, which is set to be ruled upon by the Supreme Court later this year, as a reason to wait to begin the process.

One of the most controversy parts of the Affordable Care Act is the individual mandate that requires all Americans to purchase insurance.  The Supreme Court is scheduled to hear remarks on March 25, with a final decision expected in June.  This has been a very divisive and partisan issue for the country.  For my part, though, I believe a strong argument can be made for the mandate and its ability to cut healthcare costs and improve health for Georgia …

Continue reading The Individual Mandate is a Great Thing for Georgia (and the Rest of the Country) »

Many Georgia Hospitals have outlawed smoking on their campuses. Many others have even gone as far as to state they will no longer hire employees who smoke, and they will discipline their current employees who are caught smoking. This topic really is not directly related to what I do. However, the issue has hit many large facilities in our State, and it is very interesting from a legal and moral standpoint.
Georgia is a particularly easy State to enforce these sorts of bans in, because it does not have a smoker’s rights statute, as 29 other states do. In addition, smokers are not currently considered a protected class by Federal Law, so none of the Federal employment discrimination laws seem to apply. The facilities that have these bans feel that banning smoking, a practice proven to increase your chance of disease and death, is part of their overall mission to promote the wellbeing of their patients and staff. They take a lead by example approach.
It does not appear that …

Continue reading Outlawing Smoking on Hospital Campuses »

Whether it is a patient centered medical home (PCMH) or an accountable care organization (ACO), we have all seen or read accounts on how we should change health and healthcare in the United States. And, quite frankly, we must change the dynamics in the healthcare sector to improve patient outcomes, decrease medical errors and lower healthcare costs.

But how do we go about improving the quality of care provided and patient satisfaction? First, it takes measureable data. Once the information is secured, it requires data analytics to set performance goals or metrics. After all, we have to have a way to measure the metrics that drive how and where we can improve medical care and patient satisfaction.

Many of us read the book or saw the critically acclaimed movie “Moneyball” starring Brad Pitt as the Oakland A’s General Manager Billy Beane. What was the basis of “Moneyball?” Metrics: using data to put the best possible team on the field at the lowest possible salary. …

Continue reading Metrics: Creating a New Model in Healthcare »