Nearly a quarter of the Texas population lacked health insurance in 2010, according to the most recent data released by the American Community Survey, which the U.S. Census Bureau conducted. That’s more than 5.7 million Texans.It’s likely that someone you know — and probably one you wouldn’t have guessed — doesn’t have health insurance. More than half of the uninsured are employed. More than a third have an annual household income above $50,000. And more than 1 million have college experience or post-secondary degrees.

via Interactive: Who Are the Uninsured in Texas?.

Very nicely done.

If I get a lesson from this, it’s “Stay in School. kids!” (If you live that long).

Sustainable. They keep using that word. I do not think it means what they think it means…

Permanent repeal of the flawed Medicare payment formula known as the Sustainable Growth Rate just got a lot more expensive….

via Doc Fix Just Got More Expensive – Margot Sanger-Katz – NationalJournal.com.

This article and its graph (from the NEJM), and its interesting, informative but probably useless graph, was referenced today on twitter, via the Washington Post’s Wonkblog,

Recently, the Centers for Medicaid and Medicare Services announced a scheduled cut in Medicare physician fees of 27.4% for 2012. This cut stems from the sustainable growth rate (SGR) formula used by the physician-payment system. …
To illustrate the level of inequity in this system, we broke down the national spending for Medicare physician services by state and by specialty and determined which states and specialties have contributed most to the SGR deficit between 2002, when the program was last balanced, and 2009. Although SGR spending targets are set on a national level, we computed state targets by applying the SGR’s national target growth rate to each state’s per capita expenditure, using 2002 as the base year. Our analysis is an approximation, because, unlike the SGR, we do not adjust for differential fee changes. …

We compared the state targets for the years 2003 to 2009 to actual state expenditures and added the annual difference between these figures to get a cumulative difference between the state’s spending and the SGR target. This cumulative difference was then divided by the 2002 per capita expenditure to determine the percentage growth since 2002.

via The Sources of the SGR “Hole” — NEJM.

Here are the graphs, and my attempts at explanation, and the questions I have:  Read the rest of this entry »

As the original twitterer ( @NickGenes ) said, “…because there wasn’t enough bureaucracy & expense in healthcare yet”.

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has begun the process of notifying covered entities that they are among the unlucky few who have been selected for the first Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy and security audits under the Health Information Technology for Economic and Clinical Health (HITECH) Act. …

While the first twenty covered entities have been selected, approximately another 130 remain in this audit round. HHS has indicated that it hopes to continue with proactive audits in the future and expects to become more aggressive in its enforcement of complaints.

via HHS Audits the 1% … and the Rest: First HIPAA Privacy and Security Audits Begin – Davis Wright Tremaine.

Yes, this is HITECH, the Son of HIPAA, but it all started with HIPAA.

Is it worth pointing out that HIPAA exempted itself from the unfunded mandate and paperwork reduction rules when it was enacted? I pointed out then that their assertion that it wouldn’t cause an increase in paperwork, nor was it an unfunded mandate was really unlikely.

How many Millions of dollars and man-hours are we pouring down these regulatory holes?

Well, this is good news. Remember that we were assured the information in the NPDB would be protected? Yeah, me too.

And, I don’t understand this move at all.

Law enforcement can access data bank without doctors’ knowledge

The rule, a response to the expansion of the National Practitioner Data Bank, is intended to help prevent evidence tampering.

By Carolyne Krupa, amednews staff. Posted Dec. 13, 2011.

Physicians and other health professionals no longer will be notified if someone accesses information about them through the National Practitioner Data Bank for an investigation, according to a federal rule that takes effect Dec. 23.

The rule, an exemption to the Privacy Act, is meant to prevent tampering with evidence and is limited to law enforcement agencies, said David Bowman, a spokesman for the Dept. of Health and Human Services’ Health Resources and Services Administration, which administers the data bank.

Umm, prevent tampering with WHAT evidence? by the time something’s being put in the NPDB, it’s know about by a lot of folks, and there isn’t any realy opportunity to ‘tamper with evidence’. This sounds exceptionally fishy to me. I need a better explanation than this. (I know I won’t get it).

Oh, and spot the problem with this logic (which I’ll point out after the quote):

Law enforcement agencies are authorized to see information on adverse actions against physicians such as medical board disciplinary actions and peer review sanctions. Such queries make up less than 1% of NPDB queries, with an average of 20 by law enforcement annually, according to the rule (www.gpo.gov/fdsys/pkg/FR-2011-11-23/pdf/2011-30292.pdf).

via amednews: Law enforcement can access data bank without doctors’ knowledge :: Dec. 13, 2011 … American Medical News.

When Law Enforcement was required to notify people they’d had a look at their records, their query rate was less than 1%. Now that they can do it secretly, what will that rate be? We’ll never know.

And, it’s not a tiny company with very limited resources, either…

He can’t talk to us because Apple fires employees who talk with the press without permission, but also because the company must walk a fine line in the medical arena. Right now, the U.S. Food and Drug Administration seems set on regulating the software that runs on the iPad, not the device itself, but if the FDA were to decide that Apple is marketing the iPad for regulated medical uses, it could unleash a regulatory nightmare on the company.

Apple has to carefully watch what it says when it talks about the iPad in medicine, says Bradley Thompson, a partner with the law firm Epstein Becker Green and an expert on FDA regulations. As long as they promote it as a general-use computing device, Apple should be fine. But “if they were promoting it for specific medical device uses,” he says, “they would cross a line.”

via Apple’s Secret Plan to Steal Your Doctor’s Heart | Wired Enterprise | Wired.com.

For those who wonder why many of us are against the regulate-everything environment…

I really like this idea, but …  well, see after the quote.

It’s easy to compare prices on cameras, vacations, and homes. But in the United States, patients fly blind when paying for health care. People typically don’t find out how much any given medical procedure costs until well after they receive treatment, be it a blood draw or major surgery.

This lack of transparency has contributed to huge disparities in the cost of procedures. According to Castlight Health, a startup based in San Francisco, a colonoscopy costs anywhere from $563 to $3,967 within a single zip code. EKGs can range from $27 to $143, while the price for a set of three spinal x-rays varies from as little as $38 to as high as $162.

When someone else is picking up the tab, mystery pricing is not much of a problem. But these days, even the 59.5 million Americans who get health benefits through large self-insured employers are increasingly expected to pay a percentage of the costs for their medical care.

Castlight aims to do as its name suggests: cast light on the actual costs of medical care, so that people can make informed decisions…

via Exposing the Cost of Health Care – Technology Review.

Finally! Some price transparency! Huzzah! I WANT people to recognize that spending money when there’s no clue to the charge (not cost, charge) is directly responsible for a ton of the runaway cost in medicine.

This is better then nothing. It is, and while I don’t begrudge people making money on their great idea, is this the best model?

The company sells its tool to self-insured employers, who pay a fee per covered member per month, and in turn offer employees access so they can become more responsible users of their benefits. It has raised $81 million in venture funding to date. Current customers include Safeway and Life Technologies, a leading maker of genomics tools.

“Castlight is further along than anybody else in helping big employers show their employees that the individual decisions they make on health care actually do have a cost that affects benefits and wages,” says Matthew Holt, co-chairman of Health 2.0, a health-care consultancy firm.

Okay, better than nothing, and a start in the right direction. Good for them.

Update: this happened 2 years ago. So, I wrote this thinking it was a new development, but it isn’t. Anyone know how this experiment has played out?

I’ve wondered for years if hospital organizations (and big organized clinics) had done the math on whether they could do without Medicare, and apparently Mayo has. More after the quote

President Obama last year praised the Mayo Clinic as a “classic example” of how a health-care provider can offer “better outcomes” at lower cost. Then what should Americans think about the famous Minnesota medical center’s decision to take fewer Medicare patients?

Specifically, Mayo said last week it will no longer accept Medicare patients at one of its primary care clinics in Arizona. Mayo said the decision is part of a two-year pilot program to determine if it should also drop Medicare patients at other facilities in Arizona, Florida and Minnesota, which serve more than 500,000 seniors.

Mayo says it lost $840 million last year treating Medicare patients, the result of the program’s low reimbursement rates. Its hospital and four clinics in Arizona—including the Glendale facility—lost $120 million. Providers like Mayo swallow some of these Medicare losses, while also shifting the cost by charging more to private patients and insurers.

via Medicare and the Mayo Clinic – WSJ.com.

First thought: the docs at the Mayo Clinic must have gotten some amazing assurances from the clinic to drop Medicare for 2 years. (If a physician opts out of accepting medicare, and it’s an all or nothing proposition, and under current law they cannot get their medicare billing back for 2 years. No doubt this was done to keep docs from using their opt-out as political leverage, and then get it restored when payments went the way they wanted).

Second thought: Mayo just became a Concierge Clinic. Interesting.

Third: I’m very interested in knowing what administrative advantages would follow dropping Medicare. EMTALA would no longer apply, but this is a clinic, not a hospital/ED, so I’m not sure that would affect them much. (I may misunderstand the role and capabilities of this Arizona Mayo Clinic, so let me know if I’m wrong here).

There are always strings attached with taking Uncle’s money, and they don’t lessen over time, they compound. I think HIPAA is linked to Medicare, too, so that gigantic unfunded mandate could stop.

Interesting…

Wait, I was told this would Never Work.

Thanks to the passage of lawsuit reforms, medical care is now more readily available in many Texas communities. For many patients, this change has been life-altering; for some, life-saving.

via Guest Column: Better Care, Thanks to Tort Reform — Health Reform and Texas | The Texas Tribune.

Interesting think piece on pre-arranged medmal arrangements, and why they won’t currently work…

…
The one signal fact about the American court system is that, paternalistically, it generally refuses to enforce contractual arrangements of this sort. No matter how well spelled out in advance, courts will not enforce the disclaimer of liability or apply the agreed-on damage limit. You will instead get the malpractice coverage that courts and lawmakers deign to prescribe for you, not the coverage you and your medical provider might have chosen yourselves.
…

via Libertarians, Medical Malpractice and Contract | Cato @ Liberty.

Huh. That’s what I argued. Right again. #fb

In a victory for Florida pediatricians and family physicians, a federal judge has blocked a state law that restricted physicians from asking patients if they have guns at home, calling the measure unconstitutional.
…

The NRA and others said asking patients about guns in the home was a violation of privacy.
…

In her Sept. 14 opinion, U.S. District Court Judge Marcia G. Cooke said the loss of doctors’ First Amendment freedoms, even for a minimal period, constituted an irreparable injury.

“The evidence on the record shows that practitioners have eliminated questions about firearm ownership from intake questionnaires and either curtailed or stopped routine counseling on firearm safety as a result of this law,” Cooke said. “Practitioners are self-censoring themselves out of fear of disciplinary actions. Plaintiffs’ injury is their chilled free speech.”

via amednews: Federal judge bars Florida ‘don’t ask’ gun law :: Sept. 26, 2011 … American Medical News.

So, it took a Federal court to make sure the US Constitution is upheld. Too bad. That’s what they’re for. Also, not just for Florida Peds and FP’s. It’s for every American.

I was quite disheartened by the number of commenters in the linked threads who were quite certain squashing physician speech was totally legal as long as their gun owning ox didn’t get gored. (‘Business licensure’, like how dry cleaners cannot ask what that stain in the shirt is, grasping at straws gun owners should never resort to). Which is of course short sighted. And stupid.

Yeah, there may well be a challenge, but as only Florida (so far) has been as credulous as to pass this NRA sponsored legislation (disclaimer: I’m an NRA Life Member, and yes, the NRA sometimes screws up), hopefully the appeal won’t be taken up.

Look, I understand the American Academy of Pediatrics is, well, nuts on this issue (‘until recently’, when they stopped advocating for gun control, or whatever peeved the NRA), but that is NOT, as I’ve repeatedly pointed out, an excuse to suppress speech. First amendment, right above the second. (And, as I say, the second assures the first).

Speech is sometimes unpleasant, and there are places where all unpleasant speech is suppressed. You won’t like it there.

The Court of Appeal of the State of California, 5th Appellate District, has upheld the state’s $250,000 noneconomic damages cap, reaffirming what physicians nationwide consider the gold standard among tort reforms.

via amednews: California’s noneconomic damages cap upheld :: Sept. 26, 2011 … American Medical News.

via @amednews on Twitter

This underestimates the increased cost by a huge factor…

Remember how Obama recently waived new ozone regulations at the EPA because they were too costly? Well, it seems that the Obama administration is would rather make people with Asthma cough up money than let them make a surely inconsequential contribution to depleting the ozone layer:

Asthma patients who rely on over-the-counter inhalers will need to switch to prescription-only alternatives as part of the federal government’s latest attempt to protect the Earth’s atmosphere.

…But the switch to a greener inhaler will cost consumers more. Epinephrine inhalers are available via online retailers for around $20, whereas the alternatives, which contain the drug albuterol, range from $30 to $60.via Obama Administration to Ban Asthma Inhalers Over Environmental Concerns.

I added the bold in the quote to show where the increased cost is coming from: these people (who were buying these old inhalers without a prescription) are now going to have to see someone with a prescription pad, pay for that visit, and then go buy the more expensive inhalers.

The FDA made the prescription inhaler manufacturers take out the CFC’s a few years ago, and the prices of those inhalers went up substantially.

For the record, I think all these inhalers should be OTC: they’re safe and affective. Off the top of my head, 90% of the meds on the WalMart $4 list should be OTC as well.

There’s a quite instructive graph in a blog post from NRO yesterday (talking about Union campaign donations), but I found this one to be very instructive, and have added labels so the point cannot be missed:

In politics, generally what you give is what you get. I’ve taken to giving more to the PACs that represent me.

As an aside, it’s political malpractice to give only to one party (Teachers). Eventually that one party will be on the outs, and then where are you?

The headline is disingenuous: yes, there’s a Med School headed for Austin. Congrats, Brackendridge!

Kinda amusing tale after the quote:

Lawmakers and local leaders are hopeful a plan unanimously adopted at Thursday’s University of Texas System Board of Regents meeting means they could finally get what they’ve long been waiting for: a new medical school.

One of the elements of the plan outlined by Chancellor Francisco Cigarroa is to “advance medical education and research in Austin.” Even before Thursday’s meeting ended, state Sen. Kirk Watson issued a press release reading between the lines, calling for the creation of a flagship health science center and medical school in Austin. “Within the next 30 days, I plan to offer a path – and a challenge for our community – to build on [Cigarroa's] statement so we realize these goals that so many of us have shared for so long,” Watson said. “It’s time for Austin to come together and act, creating a flagship initiative that can fortify our future and lead the world in the fields of medical education, healthcare and bioscience.”

via Is the UT System Preparing for a New Medical School? — Higher Education | The Texas Tribune.

For those interested in the funny politics of a med school in Austin, you have to look back to the 1970′s.

In the 70′s, during a meeting of the Ledge, there was money set aside for a new Med School. It allegedly was understood by all involved that this school would go to Austin, but it wasn’t spelled out directly. Then, in one of those things that only happens when you have a strong Lieutenant Governor who happened to be from Lubbock, in the last minute a rider was stuck onto an unrelated bill attaching all the money and authorization of the MD School bill to Texas Tech.

From the tales (and I was between 7 and 13 at the time, so I’m literally blameless here), there was a great gnashing of teeth, but it was for naught. My Med School came to fruition, and I’m glad for it, as I graduated from that school several years later.

Amusing history, later corrected.

(Had Austin gotten a school earlier, would Tech ever have gotten one? I say nay).

I predict that Austin will not lack for med student applicants.  I’m daring, it’s true.