Health Wonk Review: Rhetorical Question Edition

Compiled By Sarah Sonies and Jennifer Salopek

A wide-ranging roundup of blog posts on such topics as costs, insurance, policy, money, and more. The rhetorical question conceit was inspired by Dr. Jaan Siderov, who asks, “Why not us bloggers?” Why not indeed?

COSTS

What happens when unauthorized immigrants age and need more than a prescription or an acute hospital stay? Brad Flansbaum at The Hospital Leader discusses the legitimacy of providing care for young, unauthorized immigrants–and what happens when they age. The post, titled “Trends Come in Threes,” examines an alarming new trend in undocumented immigrants due to an aging community—the challenge of allocating adequate resources for these individuals when they can no longer care for themselves.

Are unplanned readmissions to the hospital  truly a good indicator of hospital quality? Brad Wright at Wright on Health explores a few reasons why this might be. According to Wright, hospital readmissions are relatively easy to measure using administrative claims data. Like all hospitalizations, they cost a lot of money—and are therefore a target for reducing spending. However, a recent study from Matthew Press and colleagues published in the June issue of Health Affairs reports that many rates are spread out across the system sporadically and so may not serve well as an indicator of quality.

How do public payers set medical device reimbursement in the United States and Europe? Jason Shafrin, over at Healthcare Economist, investigates. In Europe, only cost was examined until recently, when value entered the equation. In the United States, the Center for Medicare and Medicaid Services will only reimburse for devices covered by the FDA. In both markets, a new DRG is usually created for each new device, increase in reimbursement, or a separate CPT in order to temporarily price the device.

At Disease Management Care Blog, Dr. Jaan Siderov examines “The Middle Class Bubble and the Long Term Implications for Care Management & Health Care.” He suggests that the middle class is going away and explores how the health care industry will respond. He predicts two systems will emerge, one being high-value/high-margin, while the 99 percent will be left in a high-volume/low-margin care setting. He also speculates how care management will evolve. “It’s not a pretty picture,” he says, “but someone has to think about it: Why not us bloggers?

INSURANCE

What can we learn from published insurance rates in California and Ohio? Joe Paduda at Managed Care Matters explains “rate shock”—the factors that will affect what consumers will actually pay for health insurance under the Patient Protection and Affordable Care Act (PPACA). Ohio and California are currently two of the only states with published insurance rates under the PPACA. While insurance rates are projected to rise considerably in Ohio, California customers are said to be getting a big bang for their buck. However, comparing the rates in each state presents some challenges. Paduda examines them and evaluates what they could mean for rates across the country.

How can I determine whether I qualify for a subsidy? Colorado Health Insurance Insider’s blogger, Louise, offers a post entitled, “Health Insurance Exchange Subsidy Calculations Not as Simple as They Seem.” She notes that it’s difficult to pin down exactly who will be getting health insurance subsidies because online calculators aren’t based on Colorado data; rather, they use information from the Congressional Budget Office.

Why should we worry (more) about the IRS? From John Goodman’s Health Policy Blog comes a submission by Greg Scandlen, senior policy fellow at the NCPA. In “How the IRS Monitors Tax Credits,” Scandlen explains why he is wary of chaos at the prospect of the IRS managing the many millions of expected health insurance tax credit claims.

RESEARCH

Why do we need more research into the value of colonoscopies? Tom Liu at In Sight explores how colonoscopies can often be a “real pain in the …” Using recent news coverage about the cost of colonoscopies and their effectiveness compared to cheaper screening methods as an example, Liu discusses the need for more comparative effectiveness research, providing brief contrast between randomized controlled trials and “pragmatic trials,” and highlights some of the recent work of the Patient-Centered Outcomes Research Institute.

What does it take to improve academic lab safety? In a trip to the dark side, Julie Ferguson at Workers Comp Insider looks at the painful path to academic lab safety via developments in the criminal proceedings against UCLA professor Patrick Harran related to the 2008 death of his 23-year old research assistant, Sheri Sangji.

POLICY

Could organ transplant policy changes result in inequity? At InsureBlog, Henry Stern urges health care consumers to be careful what they wish for in his post examining the case of Sarah Murnaghan in the context of policy reform. Murnaghan, who suffers from cystic fibrosis, was in need of lung transplant and received new lungs last week due to the Organ Procurement and Transplant Network’s executive committee approval of a one-year change making children younger than 12 eligible for priority on adult lung transplant lists. While many argue that organ donation policy needs reform, Stern expresses concern that the policy reform could prioritize some while unintentionally putting others in need in an eternal backseat.

Should states mandate nurse staffing ratios in acute care hospitals? Heather J. Kelley, a program associate at the Interdisciplinary Nursing Quality Research Initiative, is the author of a post on the INQRI Blog examining “Staffing, Quality, and Costs.” The New York State Nurses Association is supporting a bill in the New York state legislature that would establish required nurse staffing ratios in the state’s 185 acute care hospitals; hospitals oppose the bill, noting cost implications. This is an important conversation, given that research is demonstrating that nurse staffing levels have a definite impact on the quality of patient care. Kelley provides two examples of such research in her post.

On Anthony Wright’s Health Access Blog, we find a post entitled “Dramatic Day of Debate and Decision.” California’s passage of the ACA Medicaid expansion was expected, but what wasn’t expected was that some Republican legislators crossed over in support. Even more so, they came unanimously to improve the benefits in California’s Medicaid program to include dental coverage. In the statistically proven most polarized legislature in America, perhaps this portends a thaw in the anti-Obamacare rhetoric?

What can we learn from early Medicaid expansions under the Affordable Care act? Harvard’s Benjamin Sommers and his co-authors offer answers on the Health Affairs blog. An excerpt: “Since 2010, six states have already expanded Medicaid to cover some or all of the low-income adults targeted for coverage under health reform. To provide additional information on the impacts of such expansions, we undertook an in-depth exploration of the experiences of these states – California, Connecticut, the District of Columbia, Minnesota, New Jersey, and Washington – through qualitative interviews with 11 high-ranking Medicaid officials across all six states. In analyzing these interviews, we identified several key policy lessons that help elucidate the opportunities and challenges of expanding Medicaid under the ACA.”

DATA

Did you miss out on Health Datapalooza IV this year? What IS Health Datapalooza? HealthBlawg is next up with a comprehensive wrap-up post on the health information technology and health care policy conference in DC earlier this month. The Datapaloozers are looking at data streams from the government and beyond in an effort to manage the health and the health care costs of various populations. Better management will require better measurement. What’s Datapalooza’s mission? Accelerating improvement in health care quality by liberating the data behind health care and its costs.

Why are patient experience surveys crucial to gaining clues for improving patient care and comfort? Many hospitals use them, notes David Williams at Health Business Blog, even though providers may not always be enthusiastic about being rated. They’ve become more important since Medicare began using patient experience as a criterion for reimbursement. Williams explores the important issue of noise reduction and how surveys played a crucial role in bringing it to the fore.

MONEY

Our next submission examines the fine line some charities must walk between raising awareness and supporting patients affected by disease; and protecting their interests in an industry becoming more and more like a business marketplace. Roy Poses at Health Care Renewal examines how some leaders of charitable foundations might have interests that lean increasingly towards business ventures. In the current age of business, where should charitable foundations draw the line between healthy business ventures and expanding too far away from the mission? If we allow health care to be run primarily for the financial benefit of clever insiders, should we expect good care when we get sick?

Is the HMA story a new take on an old issue, “money-driven” medicine? A June 9 CBS News story examined employee allegations that the for-profit hospital chain, Health Management Associates (HMA), pressured its physicians to increase patient readmissions, regardless of need for hospitalization, in order to raise hospital revenues. The in-depth CBS profile led to the resignation of HMA’s CEO and to rumors of an impending takeover. Maggie Mahar at Health Beat Blog takes a look at the implications.

ET CETERA

Read any good books lately? A new book on neuroscience, Brainwashed, authored by psychiatrist Sally Satel and clinical psychologist Scott Lilienfeld, critically analyzes the field of neuroscience and the recent buzz in the media about brain imaging. According to the authors, brain scan imaging may someday reveal certain mysteries about how the brain works, they say, but today’s color-dappled images are not the window into the mind that some people are making them out to be. Jared Rhoads provides a comprehensive review of the book on his website, Health Care Book Reviews.

15 thoughts on “Health Wonk Review: Rhetorical Question Edition

  1. OUTSTANDING job, Sarah and Jennifer! It’s obvious that you’ve read each entry, and I really like the context and commentary that accompanies each one.

    Kudos!

  2. I hear a lot about Obama Care. How everyone will now be covered. How health insurance will be affordable for everyone. From the other side, how it is a mess an unsustainable. All I know is every year my insurance coverage gets worse and more expensive.

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