Comments for Healthcare Town Hall

Comment on Accountable care organizations: The new provider model? by Daniel Connelly

Daniel Connelly — Tue, 31 Aug 2010 00:43:37 +0000

ACOs are DOA?
The ACO concept is a rehash of the failed PPO concept of the early 1990’s. The ACO concept is not financially viable for the following reasons. As stated in the article, risk and responsibilities are to be transfered from insurance companies and medicare to the ACO. These groups have neither the deep pockets of insurance company reserves nor the ability to print money like medicare, yet they will be asked to be defacto insurance companies. The ACO will not only be responsible for patients within the ACO , but also for all the patient costs outside the plan within a specific geographic area. Mathmatically, this is a plan for rapid bankruptcy.
An additional note, medicare beneficiaries will lose their choice of physicians. The law states that HHS will decide to which ACO a beneficiary will be assigned. “The devil is in the details”.

Comment on The ACO challenge: Managing to targets by Stellarpoint CEO

Stellarpoint CEO — Thu, 19 Aug 2010 15:46:17 +0000

Excellent Post…Thanks

I think your post and the associated paper hit the nail right on the head when you stated – “Without medical management services working the supply side and demand side, utilization will almost always exceed targets.”

As everyone continues to focus on the many variables associated with healthcare reform, there needs to be more attention focused on balancing both sides of the equation.

Thanks again…

Comment on How can medical homes capture public awareness? by Zelma Zuniga

Zelma Zuniga — Thu, 19 Aug 2010 13:20:21 +0000

Nice! Blood pressure and hypertension have been interests of mine for a long time, and I think that a balanced holistic approach is overall the most promising. You have to eat healthy, exercise, and regularly watch your blood pressure and cholesterol levels, and then things should be not too hard.

Comment on Cost control by Mike Koriwchak MD

Mike Koriwchak MD — Thu, 19 Aug 2010 09:30:57 +0000

@Marc Wilton, MD
Marc, I like your comments. Here’s a few other thoughts:

1. The depersonalization problem comes from giving IT folks too much leeway in designing EMR systems. No disrespect to IT folks meant here – their way of thinking works great in their own field but just doesn’t translate well to ours. I designed the templates for our EMR myself and avoided overuse of blanks and drop down menus, opting instead for “physician narratives”. That allows us to document well the human element to a patient’s background that you correctly point out is often missed.

2. Because of CPT billing requirements EMR entries are often quite long and contain too much “white noise” – too much demographics, too many irrelevant details, etc. I have seen 5 pages EMR notes for a patient that came in with impacted ear wax!

3. Docs MUST take the lead in EMR implementation. If we oppose EMR and CPOE because we dwell on its shortcomings then our history with managed care will repeat itself. We will allow non-physicians to create and force upon us a completely unworkable system.

Comment on Four ways to reduce ICD-10 risk by John Lynn

John Lynn — Thu, 12 Aug 2010 19:56:10 +0000

Not a bad list for people to consider as they move to ICD-10

Comment on The status quo can’t last by Stellarpoint CEO

Stellarpoint CEO — Tue, 27 Jul 2010 17:05:19 +0000

Great Points…Thanks

I think your briefing paper clearly pointed out a situation that needs to be addressed by everyone – Healthcre Providers, Employers, Employee Plans, and Government Programs.

The “Baby Boomers” – and I am one of them, are getting older and living longer. As someone who is very involved with all of the various groups, I see strong resistance to changing the “Status Quo.” Everyone wants better healthcare; but, everyone also wants to pay less or make more in overall profits. This equation does not work. The model needs to be changed and all of us need to be part of the process.

I appreciate all of your contributions. Thanks again for the post…

Comment on How can an annuity fund long-term care? by tim ripp

tim ripp — Mon, 26 Jul 2010 19:09:49 +0000

It is my understanding that PPA ‘06 allows for both tax free surrenders to either pay HIPPA qualified LTC cliams or TQ LTC Premiums via partial 1035 surrenders. (1099-LTC) The requirement that the distributions have to be pro-rated basis vs gain, causes many annuity companies not to be able to handle the request. But the intention of the act was to free up monies from NTQ annuities (most of which currently goes to the annuitant estate) on a tax free basis to fund LTC claims. The distrbutions to a TQ LTC policy must be accomplished via a partial 1035 surrender. Many of the major LTC carriers (John Hancock, MetLife, Prudential) are currently not accepting premium payments this way. Currently Genworth is set up and equiped to accept this 1035 transfers.

Comment on Cost control by Marc Wilton, MD

Marc Wilton, MD — Thu, 15 Jul 2010 15:55:13 +0000

EMRs depersonalize patients by presenting them as boxes to be checked and blanks to be filled in and, of course, make privacy of medical information even more of a joke than it is now. In addition, EMRs present the patient as nothing more than collection of data. My own doctor, whose office spent $500,000 for an EMR system, says when he looks at each EMR, it’s only clinical information – “I can’t tell who that person *is*. Yet, excellence in diagnoses and treatment includes far more than just clinical information. It includes knowledge (not just test results or boxes checked) of patients’ histories, family situations, current work and home situations, psychosocial stresses – all contemplated and processed in a cognitive fashion by a well-trained physician.

Government medicine doesn’t allow for that. It’s goal is to reduce costs through standardization, reduction in services, and delegation of diagnoses and treatment to the less-trained. Patients, however, aren’t “standard” – and never will be.

To see the future of socialized medicine in the U.S., look at what’s happening now with the British National Health Service (you won’t see this in any American media):
http://www.dailymail.co.uk/health/article-1016262/Grandmother-dies-NHS-cancer-treatment-withdrawn-paid-privately-life-extending-drug.html

http://www.dailymail.co.uk/news/article-1054606/Patients-turn-black-market-buy-cancer-drugs-pay-NHS-treatment-warn-experts.html

Cash is king. It always will be. If patients paid physicians directly, as they did pre-Medicare, instead of paying thousands of government workers (and unnecessary workers in doctors offices to process claims) healthcosts would plummet. Doctors would be responsible to their patients, not to the government. There is no better watchdog of a patient’s wallet than the patient.

Comment on Risk adjustment: Health calculus for the reform environment by Stellarpoint CEO

Stellarpoint CEO — Mon, 05 Jul 2010 11:35:40 +0000

Good Article…

I believe your article hit on one of the key issues that many people are going to be dealing with over the next few years.

Healthcare expenditures, especially for employer groups are only going to get more complicated in the short term. The ability to evaluate risk and integrate its effects on certain healthcare options is going to be key for all of us.

Thanks for the excellent post…

Comment on Will reform make people more aware of their long-term care needs? by Ross Schriftman

Ross Schriftman — Fri, 02 Jul 2010 13:10:47 +0000

Any financial advisor or insurance agent that recommends that their clients sign up for CLASS will open themselves up to liability and their malpractice insurance will NOT protect them. That is because the Class Act can not be described as insurance. It is NOT. No participant will get an insurance policy or even a certificate. It cannot be described as a savings account as the President and the Secretary of HHS described it. No one will have an account in their name.

The only reason it was put into the so called health care reform was so that the Congressional Budget Office numbers would look beter. Who in their right mind would voluntarily send their hard earned paycheck to a government that is already $13 trillion in debt?

This does not replace nor supplement real long term care insurance. I own it on myself. I had purchased it on my Mom who died last year of Alzheimers. It helped pay for her care so she could remain at home as I had a great live in companion and I could work during the day. I am glad I had it.

People would rather deal with a licensed and trained personal insurance agent to help them select coverage rather than a government bureacrat per Firman