Highlights of the important and the interesting from the world of healthcare:
Why we must change how primary care docs get paid: A study of how primary care doctors at one Philadelphia practice spend their time yields some disturbing results, and further shows why primary care is becoming a less-and-less desirable field to enter. Each primary care doctor must perform numerous tasks each day that are often urgent and important, but for which there is no compensation. The Wall Street Journal has the full rundown, but here are just a few items, per day, per doctor: 24 phone calls, 17 e-mails, review 20 lab reports and 11 imaging reports (nurses and other staffers do help with some of these tasks). And that’s in addition to physicians’ responsibilities in seeing nearly 19 patients a day–the only activity for which these doctors typically get paid.
It’s important to note that the study may or may not be representative of the typical practice–it used data from the electronic medical records of a five-physician Philadelphia practice, Greenhouse Internists. Nonetheless, it starkly illustrates why primary care doctors must be compensated for patient-care tasks that don’t involve direct patient visits. Otherwise, the already unpopular and undercompensated field, which attracts only about 10 percent of medical students, will continue to wilt under pressure, leaving many Americans without access to care. Further, the study suggests that we must find some way to shuttle these sorts of low-level patient-care tasks from doctors to nurses.
With the Rise of AI, What IP Disputes in Healthcare Are Likely to Emerge?
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
Trouble in Boston: Federal investigators are looking into whether a premier Boston health system engaged in anticompetitive behavior. The investigation could (repeat, could) be a precursor to formal charges by the Justice Department that Partners Healthcare System used its market power to artificially inflate prices. Based on a 2008 study by the Boston Globe that Partners’ market power allows it it to charge prices 15 to 60 percent higher than other hospitals for doing the same work, charges certainly seem like at least a possibility.
Partners might try to retort that its prices are higher because it provides a higher quality of care, but that doesn’t jibe with a report earlier this year by the Massachusetts attorney general. Further, that same report suggests that a primary driver behind high health costs isn’t overutilization of medical services, but price hikes. As more light is shed on the exorbitant and opaque prices that some hospitals seem to charge, it can only be a good thing for cash-strapped American patients.
Sorry about that “miscalculation”: Just when hospitals that (allegedly) jack up prices start to make health insurers look good (or at least not so bad), California’s Anthem Blue Cross comes along and blows it all. The insurer, whose parent company is Wellpoint, backed off plans to raise premiums in the individual market by as much as 39 percent. Did the insurer have a “come-to-Jesus” moment, realizing these rate hikes would deprive struggling working families of the care they need? Um, not quite. It was essentially shamed into the move by the state’s Department of Insurance, which found the insurer used “deeply flawed” math and assumptions to justify the hike, the Sacramento Bee reports.
The company admitted to “inadvertent miscalculations” in the matter. The state’s largest insurer said it plans to refile its rates in May, but would not say how big the increases will be or how soon they might be in place. Meanwhile, Wellpoint’s first-quarter profits jumped 51 percent to $866 million, which didn’t earn the insurer a lot of sympathy in California.
A Personalized Approach to Medication Nonadherence
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
The waste in billing: A study from Massachusetts General Hospital estimates that the U.S. health system could save $7 billion a year by streamlining its inefficient third-party payment system. Researchers calculated the costs of administering different claims from so many different insurers and found that between labor costs and lost revenue from delayed or mistakenly rejected claims, it added up to $45 million in 2006, or 12 percent of patient revenue, for the hospital’s physicians’ organization. It then extrapolated the $7 billion number from that data.
Researchers took pains to say that the savings could be had from measures that would streamline the existing system–such as a single set of payment rules for all payers, a single claim form and standardized submission–as opposed to instituting a single-payer system. But that makes one wonder, exactly how much would single-payer save?
Photo from flickr user Joe Shlabotnick
