tag:blogger.com,1999:blog-42074516474152221612023-11-15T09:08:07.309-08:00Health Policy and a PintRaise a glass to your Health!Sylviahttp://www.blogger.com/profile/06325799042672079572noreply@blogger.comBlogger13125tag:blogger.com,1999:blog-4207451647415222161.post-41873635087469841142009-11-29T18:29:00.000-08:002009-11-29T18:31:43.082-08:00Health Care Reform and Abortion<p><span style="font-family:Times New Roman;"><b><span class="Apple-style-span" style="font-size: large;">H.R. 3692 and aborti</span></b><b><span class="Apple-style-span" style="font-size: large;">on</span></b></span><b><span class="Apple-style-span" style="font-size: large;"><br /></span></b> </p> <p><span style="font-family:Times New Roman;"><b><span class="Apple-style-span" style="font-size: large;">What does the Stupak Amendment say?</span></b></span><b><span class="Apple-style-span" style="font-size: large;"> </span></b><br /></p> <p><span style="font-family:Times New Roman;font-size:100%;">Abortion Funding:</span></p> <ul type="DISC"> <li><span style="font-family:Times New Roman;font-size:100%;">No federal funds authorized or appropriated by health reform can be used to pay for abortion</span></li> <li><span style="font-family:Times New Roman;font-size:100%;">The public plan can only provide abortion coverage in cases of rape, incest, and when the life of the woman is in danger (similar to the current Medicaid restriction)</span></li> <li><span style="font-family:Times New Roman;font-size:100%;">Individuals can purchase either a private insurance plan that covers abortion in the government-run marketplace, the Exchange, or supplementary abortion coverage “abortion rider.”</span></li> <ul type="DISC"> <li><span style="font-family:Times New Roman;font-size:100%;">The ‘abortion rider’ is not available to anybody who purchases the public plan</span></li></ul></ul> <p><span style="font-family:Times New Roman;font-size:100%;">Who is most likely to be impacted by the Stupak Amendment?</span><br /></p> <ul type="DISC"> <li><span style="font-family:Times New Roman;font-size:100%;"><b>Any individual choosing to purchase health insurance through the Exchange</b> will be tied by the Stupak amendment. People eligible to purchase through the Exchange include the following groups:</span></li> <ul type="DISC"> <li><span style="font-family:Times New Roman;font-size:100%;">Uninsured individuals</span></li> <li><span style="font-family:Times New Roman;font-size:100%;">People with individual health plans</span></li> <li><span style="font-family:Times New Roman;font-size:100%;">People working for small business (starting in 2013)</span></li> <li><span style="font-family:Times New Roman;font-size:100%;">People working for large companies (starting in 2015)</span></li> </ul></ul> <br /><ul type="DISC"> <li><span style="font-family:Times New Roman;font-size:100%;">Medicaid recipients (status quo, abortion is currently restricted for Medicaid recipients under the Hyde Amendment except in cases of rape, incest or danger to the woman’s life).</span></li></ul> <p><span style="font-family:Times New Roman;font-size:100%;">Other points:</span></p> <ul type="DISC"> <li><span style="font-family:Times New Roman;font-size:100%;">The Hyde Amendment (above) has to be renewed annually</span></li> <li><span style="font-family:Times New Roman;font-size:100%;">The current language in H.R. 3692 codifies into federal law the restrictive abortion provisions, and <b>they do not require annual approval.</b></span></li></ul> <p><span style="font-family:Times New Roman;font-size:100%;">What next?</span></p> <ul type="DISC"> <li><span style="font-family:Times New Roman;font-size:100%;">The Senate has to vote on its health reform bill, which currently does not have the Stupak amendment language in it. </span></li> <li><span style="font-family:Times New Roman;font-size:100%;">Once the Senate bill passes, it joins H.R. 3692 to Conference Committee to be merged into one bill</span></li></ul> <p><span style="font-family:Times New Roman;"><b><span class="Apple-style-span" style="font-size: large;">Want to take action?</span></b></span><b><span class="Apple-style-span" style="font-size: large;"> </span></b><br /></p> <p><span style="font-family:Times New Roman;font-size:100%;"><b>Click here to send an e-mail to your Senators and Representatives, urging them to protect the reproductive rights of women:</b></span><br /></p> <p><a href="http://www.capwiz.com/ams/issues/alert/?alertid=14351641&type=CO" target="_blank"><span style="font-family:Times New Roman;font-size:100%;color:#2c42ba;"><b><u>http://www.capwiz.com/ams/<wbr>issues/alert/?alertid=<wbr>14351641&type=CO</u></b></span></a><br /></p> <p><span><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;">The Stupak-Pitts amendment represents an unprecedented erosion of a women's right to choice and a dangerous expansion of the current restrictions on the use of federal funds for abortion with potentially devastating consequences for millions of low- and middle-income women. </span></span></span></p> <p><span><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;">This amendment goes further than any previous federal law to rest</span></span></span><span><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;">rict access to abortion - and it's up to us to ensure it is removed before the legislation is enacted into law. It would prohibit millions of women from getting coverage for abortion in their health insurance plans, even if they pay for it themselves. This is a stunning blow to a woman’s right to choice in this country.</span></span></span></p> <p><span><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;">As physicians and physicians-in-training, we must continue to advocate for reform that will benefit all of our patients and our communities while not hesitating to speak against provisions l</span></span></span><span><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;">ike the Stupak amendment that will do more harm than good. </span></span></span><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></p> <p><span><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;">We must act now and tell our Senators and Representatives that the language in the House bill will cause women to lose coverage, that language should be changed and should not be included in the Senate bill.</span></span></span><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;"> </span></span><br /><br /> </p>JRLDhttp://www.blogger.com/profile/04600844319585409807noreply@blogger.com0tag:blogger.com,1999:blog-4207451647415222161.post-26589018381713848142009-09-19T09:59:00.000-07:002009-09-19T10:01:37.364-07:00<p style="margin-left: 0pt; margin-right: 0pt;"><span style="font-family: 'Times New Roman';"><span style="font-size:100%;">Health Policy and a Pint: September 2009</span></span></p><p style="margin-left: 0pt; margin-right: 0pt;"><span style="color: rgb(153, 51, 0); font-family: 'Arial Rounded MT Bold';"><span style="font-size:130%;">September Topic: Truths about government run healthcare programs</span></span></p><p style="margin-left: 0pt; margin-right: 0pt;"><span style="font-family: 'Arial';"><span style="font-size:130%;">Reid, TR “Five Myths About Healthcare in the Rest of the World”. Washington Post. 23 Aug 2009. </span></span></p><p style="margin-left: 0pt; margin-right: 0pt;"><a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778.html"><span style="color: rgb(0, 0, 255); font-family: 'Arial';"><u><span style="font-size:130%;">http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778.html</span></u></span></a></p><p style="margin-left: 0pt; margin-right: 0pt;"><span style="font-family: 'Arial';"><span style="font-size:130%;">Kerr, DJ and Scott M “British Lessons on Healthcare Reform” New England Journal of Medicaine. 9 Sep 2009. </span></span></p><p style="margin-left: 0pt; margin-right: 0pt;"><a href="http://healthcarereform.nejm.org/?p=1702"><span style="color: rgb(0, 0, 255); font-family: 'Arial';"><u><span style="font-size:130%;">http://healthcarereform.nejm.org/?p=1702</span></u></span></a></p><p style="margin-left: 0pt; margin-right: 0pt;"><span style="font-family: 'Arial';"><span style="font-size:130%;">What really happens in countries that have government administered health</span></span> <span style="font-family: 'Arial';"><span style="font-size:130%;">care programs? Are these models better or worse than </span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">our current system</span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">? This month’s articles provide </span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">some </span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">an </span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">overview of how other industrialized countries provide health</span></span> <span style="font-family: 'Arial';"><span style="font-size:130%;">care to all of their citizens</span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">, </span></span> <span style="font-family: 'Arial';"><span style="font-size:130%;">and how that compares with </span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">the </span></span> <span style="font-family: 'Arial';"><span style="font-size:130%;">U</span></span> <span style="font-family: 'Arial';"><span style="font-size:130%;">.S. system</span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">. </span></span></p><p style="margin-left: 0pt; margin-right: 0pt;"><span style="font-family: 'Arial';"><span style="font-size:130%;">Questions for discussion:</span></span></p><p style="margin-left: 0pt; margin-right: 0pt;"><span style="font-family: 'Arial';"><span style="font-size:130%;">1. Are these models </span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">similar to </span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">the kind of health</span></span> <span style="font-family: 'Arial';"><span style="font-size:130%;">care system that you would want to work and live in? Why? What important elements would you like to see in place to meet the needs of your patients and your profession? </span></span></p><p style="margin-left: 0pt; margin-right: 0pt;"><span style="font-family: 'Arial';"><span style="font-size:130%;">2. What are your greatest concerns about how health</span></span> <span style="font-family: 'Arial';"><span style="font-size:130%;">care is administered</span></span><span style="font-family: 'Arial';"><span style="font-size:130%;"> in the U.S.</span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">? </span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">Other countries? </span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">What are the most important things that a health</span></span> <span style="font-family: 'Arial';"><span style="font-size:130%;">care system should address? What are some ways that those concerns could be addressed? </span></span></p><p style="margin-left: 0pt; margin-right: 0pt;"><span style="font-family: 'Arial';"><span style="font-size:130%;">3. Do you think that it’s important</span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">,</span></span><span style="font-family: 'Arial';"><span style="font-size:130%;"> as future physicians</span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">,</span></span><span style="font-family: 'Arial';"><span style="font-size:130%;"> to be well</span></span><span style="font-family: 'Arial';"><span style="font-size:130%;"> informed about the kinds of health</span></span> <span style="font-family: 'Arial';"><span style="font-size:130%;">care delivery systems </span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">in which </span></span><span style="font-family: 'Arial';"><span style="font-size:130%;"> </span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">you may find yourself working</span></span><span style="font-family: 'Arial';"><span style="font-size:130%;"> in</span></span><span style="font-family: 'Arial';"><span style="font-size:130%;">? Have you heard some of these common myths circulating among your peers? How can you help to dispel these myths? </span></span></p><p style="margin-left: 0pt; margin-right: 0pt;"><span style="font-family: 'Arial';"><span style="font-size:130%;">Want to get involved and take action? </span></span></p><p style="margin-left: 0pt; margin-right: 0pt;"><span style="color: rgb(36, 36, 36); font-family: 'ArialMT';"><span style="font-size:130%;">Call your representatives in Congress and tell them what you, as a future physician, feel are the important components of healthcare reform. Enter your voting zip code at </span></span><a href="http://www.capwiz.com/ams/dbq/officials/"><span style="color: rgb(98, 137, 190); font-family: 'ArialMT';"><span style="font-size:130%;">http://www.capwiz.com/ams/dbq/officials/</span></span></a><span style="color: rgb(36, 36, 36); font-family: 'ArialMT';"><span style="font-size:130%;"> and get their contact information!</span></span></p><p style="margin-left: 0pt; margin-right: 0pt;"><span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">Want more information on Health Care Reform? Check out AMSA Health Care Reform website. It includes information on AMSA’s activities related to </span></b></span><span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">healthcare </span></b></span><span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">H</span></b></span><span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">ealth</span></b></span><span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;"> C</span></b></span><span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">are </span></b></span><span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">for </span></b></span><span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">all </span></b></span><span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">A</span></b></span><span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">ll </span></b></span><span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">and links to ReformsKool</span></b></span><span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">! </span></b></span><span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">,</span></b></span> <span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">A </span></b></span><span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">a</span></b></span> <span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">weekly </span></b></span><span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">newsletter </span></b></span><span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">digest </span></b></span><span style="color: rgb(0, 17, 132); font-family: 'Arial-BoldMT';"><b><span style="font-size:130%;">on Health Care Reform background, buzz words, current issues and much more!</span></b></span></p><p style="margin-left: 0pt; margin-right: 0pt;"><a href="http://www.amsa.org/uhc/hcr.cfm"><span style="color: rgb(0, 0, 255); font-family: 'Times New Roman';"><u><span style="font-size:130%;">http://www.amsa.org/uhc/hcr.cfm</span></u></span></a></p>JRLDhttp://www.blogger.com/profile/04600844319585409807noreply@blogger.com1tag:blogger.com,1999:blog-4207451647415222161.post-31440564646118711562009-08-17T16:49:00.000-07:002009-08-17T19:37:34.991-07:00August Topic: Health Care and American Values<span class="Apple-style-span" style=" border-collapse: collapse; font-family:arial, sans-serif;"><div><!--StartFragment--> <p class="MsoNormal"></p><div><span class="Apple-style-span" style="border-collapse: separate; font-size:small;"><div><b> <!--StartFragment--> <p class="MsoNormal"><span class="Apple-style-span" style="font-weight: normal;">Brett AS. “American Values” – A Smoke Screen in the Debate on Healthcare Reform. </span><i><span class="Apple-style-span" style="font-weight: normal;">N Engl J Med</span></i><span class="Apple-style-span" style="font-weight: normal;"> 2009;361:440-441.</span></p> <p class="MsoNormal"><a href="http://content.nejm.org/cgi/content/full/361/5/440"><span class="Apple-style-span" style="font-weight: normal;">http://content.nejm.org/cgi/content/full/361/5/440</span></a><span class="Apple-style-span" style="font-weight: normal;"> </span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-weight: normal;">In the past couple of months, many arguments have been raised for or against different health reform proposals. As Dr. Brett notes, much of the rhetoric revolves around notions of “American Values” with a number of assumptions about what those values are. In this article, Dr Brett explores some of these assumptions and discusses why they are often misleading and erroneous.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-weight: normal;">Possible discussion topics:</span></p> <p class="MsoListParagraphCxSpFirst" style="text-indent:-.25in;mso-list:l0 level1 lfo1"><span class="Apple-style-span" style="font-weight: normal;">1.</span><span style="font:7.0pt "Times New Roman""> </span><span class="Apple-style-span" style="font-weight: normal;">What do you feel are true American Values in relation to healthcare reform? How would you propose to incorporate those into a reformed healthcare system?</span></p> <p class="MsoListParagraphCxSpMiddle" style="text-indent:-.25in;mso-list:l0 level1 lfo1"><span class="Apple-style-span" style="font-weight: normal;">2.</span><span style="font:7.0pt "Times New Roman""> </span><span class="Apple-style-span" style="font-weight: normal;">Dr. Brett says “suppose that ‘freedom to choose’ is indeed the paramount American value relevant to healthcare.” He explores what “choice” might mean in this context. What does it mean to you? What sort of “freedom of choice” do you feel is appropriate in healthcare reform? How can that be achieved?</span></p> <p class="MsoListParagraphCxSpMiddle" style="text-indent:-.25in;mso-list:l0 level1 lfo1"><span class="Apple-style-span" style="font-weight: normal;">3.</span><span style="font:7.0pt "Times New Roman""> </span><span class="Apple-style-span" style="font-weight: normal;">The article describes the desired goal of healthcare reform as being “efficient, cost-effective healthcare.” What does this mean? How can it best be achieved?</span></p> <p class="MsoListParagraphCxSpMiddle" style="text-indent:-.25in;mso-list:l0 level1 lfo1"><span class="Apple-style-span" style="font-weight: normal;">4.</span><span style="font:7.0pt "Times New Roman""> </span><span class="Apple-style-span" style="font-weight: normal;">Do you feel patients should have the freedom to choose whatever tests or treatments they want? If so, how should they be paid for? If not, how should they be rationed?</span></p> <p class="MsoListParagraphCxSpLast" style="text-indent:-.25in;mso-list:l0 level1 lfo1"><span class="Apple-style-span" style="font-weight: normal;">5.</span><span style="font:7.0pt "Times New Roman""> </span><span class="Apple-style-span" style="font-weight: normal;">What type of reform do you feel will help support the values you believe should exist in a healthcare system?</span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-weight: normal;">What you can do:</span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-weight: normal;">Call your representatives in Congress and tell them what you, as a future physician, feel are the important components of healthcare reform. Enter your voting zip code at </span><a href="http://www.capwiz.com/ams/dbq/officials/"><span class="Apple-style-span" style="font-weight: normal;">http://www.capwiz.com/ams/dbq/officials/</span></a><span class="Apple-style-span" style="font-weight: normal;"> and get their contact information!</span></p><p class="MsoNormal"><span class="Apple-style-span" style="font-weight: normal;"><span class="Apple-style-span" style="border-collapse: collapse; color: rgb(51, 51, 51); line-height: 18px; "></span></span></p><div><span class="Apple-style-span" style="border-collapse: separate; font-size: small; "><span class="Apple-style-span" style="color: rgb(0, 0, 153); "><b>Want more information on Health Care Reform? Check out ReformsKool! A weekly newsletter on Health Care Reform background, catch phrases, current issues and much more!</b></span></span></div><div><span class="Apple-style-span" style="border-collapse: separate; "><br /></span></div><div><span class="Apple-style-span" style="border-collapse: separate; font-size: small; "><span class="Apple-style-span" style="color: rgb(0, 0, 153); "><b></b></span><a href="http://www.amsa.org/hp/ReformsKoolIssue1.pdf" style="color: rgb(102, 153, 204); ">Issue 1</a> <a href="http://www.amsa.org/hp/ReformsKoolIssue2.pdf" style="color: rgb(102, 102, 153); ">Issue 2</a> <a href="http://www.amsa.org/hp/ReformsKoolIssue3.pdf" style="color: rgb(102, 153, 204); ">Issue 3</a> <a href="http://www.amsa.org/hp/ReformsKoolIssue4.pdf" style="color: rgb(102, 153, 204); ">Issue 4</a></span></div><p></p> <!--EndFragment--> </b></div></span></div><p></p></div><div><span class="Apple-style-span" style="border-collapse: separate; font-size:small;"></span></div><div><span class="Apple-style-span" style="border-collapse: separate; font-size:small;"></span></div><div><span class="Apple-style-span" style="border-collapse: separate; font-size:small;"></span></div></span>Sylviahttp://www.blogger.com/profile/06325799042672079572noreply@blogger.com1tag:blogger.com,1999:blog-4207451647415222161.post-44401612585748651782009-06-19T10:19:00.000-07:002009-06-24T16:39:06.340-07:00HP&P and PNHPPhysicians for a National Health Program (PNHP) has indicated to AMSA that their members would be eager to talk to medical students at Health Policy and a Pint! To contact your local PNHP chapter, find your state on their website. This is a great opportunity to get a single-payer perspective at one of your chapter's HP&P meetings.<br /><br />Coming next month... What can your chapter do to impact health policy? We'll provide easy, actionable items related to the topic so your members can get involved!JRLDhttp://www.blogger.com/profile/04600844319585409807noreply@blogger.com0tag:blogger.com,1999:blog-4207451647415222161.post-75052038646336705402009-06-19T10:13:00.000-07:002009-06-19T10:15:24.307-07:00June Topic: McAllen, TX & the Health Care Cost Conundrum<p><span style="font-family:Times New Roman;font-size:100%;">In a recent New Yorker article, Atul Gawande describes McAllen, a small town in Texas, where health spending has spiraled out of control in the past two decades. Gawande characterizes McAllen as a place where the “medical community came to treat patients the way subprime mortgage lenders treated home buyers: as profit centers.” Average per capita spending is more than $15,000 in McAllen, compared to $7500 in nearby El Paso. Much of this discrepancy is attributed to the “culture of medicine” in each of these two cities. </span><br /></p> <p><span style="font-family:Times New Roman;font-size:100%;">Questions to ponder:</span><br /></p> <ul type="disc"><li><span style="font-family:Times New Roman;font-size:100%;">What role does the “culture of medicine” play in skyrocketing health care costs and should this culture be regulated?</span></li><li><span style="font-family:Times New Roman;font-size:100%;">What responsibility do physicians have to contain health care spending and prevent overutilization of health care services?</span></li><li><span style="font-family:Times New Roman;font-size:100%;">How might accountable care organizations (ACOs) mitigate financial incentives for overutilization and incentivize high quality care without infringing on provider autonomy?</span></li></ul> <br /><br /><p><span style="font-family:Times New Roman;font-size:100%;">Resources:</span></p> <p><span style="font-family:Times New Roman;font-size:100%;">Atul Gawande, The Cost Conundrum, New Yorker, June 1, 2009:</span></p> <p><a href="http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande" target="_blank"><span style="font-family:Times New Roman;font-size:100%;color:#0000ff;"><u>http://www.newyorker.com/<wbr>reporting/2009/06/01/090601fa_<wbr>fact_gawande</u></span></a><br /></p> <p><span style="font-family:Times New Roman;font-size:100%;">Fisher et al., Foster Accountable Health Care, </span><span style="font-family:Arial;font-size:85%;"><i>Health Affairs</i>, 28, no. 2 (2009): w219</span></p> <p><a href="http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w219v1%29" target="_blank"><span style="font-family:Times New Roman;font-size:100%;color:#0000ff;"><u>http://content.healthaffairs.<wbr>org/cgi/content/abstract/<wbr>hlthaff.28.2.w219v1)</u></span></a><br /></p> <p><span style="font-family:Times New Roman;font-size:100%;">Fisher et al., Creating Accountable Care Organizations, </span><span style="font-family:Arial;font-size:85%;"><i>Health Affairs</i>, 26, no. 1 (2007): w44-w57</span></p> <p><a href="http://content.healthaffairs.org/cgi/content/abstract/26/1/w44" target="_blank"><span style="font-family:Times New Roman;font-size:100%;color:#0000ff;"><u>http://content.healthaffairs.<wbr>org/cgi/content/abstract/26/1/<wbr>w44</u></span></a></p>JRLDhttp://www.blogger.com/profile/04600844319585409807noreply@blogger.com0tag:blogger.com,1999:blog-4207451647415222161.post-39949295396891685472009-03-13T15:59:00.001-07:002009-03-13T16:08:16.701-07:00<span style="color: rgb(204, 0, 0); font-weight: bold;font-size:180%;" >March: The National Convention Edition of Health Policy and a Pint</span><br /><br /><span style="font-size:130%;">This month, we're discussing the role of medical students in the upcoming health care reform. As part of the convention's theme, "Win Back our Profession", we want to know what YOU think about medical professionals as political advocates. </span><br /><br />Questions to Consider:<br /><ul><li>Is this a part of the new medical professionalism?<br /></li><li>Is it appropriate for physicians to "take sides" in politics? How might this affect our patients who disagree with us politically?<br /></li><li>When, if ever, does political involvement constitute an abuse of our influence as physicians?<br /></li><li>What is the power of medical students to enact political change?</li><li>How can we best unite medical students behind a common goal?<br /></li><li>What skills do we have? What are our resources?<br /></li><li>How can we best use our power and skills to support meaningful reform?</li></ul>If you missed convention this year, I hope you can discuss these topics at your home institutions. Check back for discussion from convention attendees!<br /><br />I say AMSA<br />You say powerJRLDhttp://www.blogger.com/profile/04600844319585409807noreply@blogger.com0tag:blogger.com,1999:blog-4207451647415222161.post-7381368912590509022008-10-21T09:02:00.000-07:002008-10-21T09:18:29.398-07:00OCTOBER Topic: Special Election-Themed HP&P<span style="font-size:130%;">OBAMA vs MCCAIN: Who will deliver quality, affordable healthcare for all? </span><br /><br />With all the back-and-forth about health care in this year's presidential election, sometimes it can be hard to know what to think about the candidate's plans. Having a discussion with fellow medical students can be a great way to find out more about the plans and debate their relative merits.<br /><br />The AMSA scorecard on the candidate's plans is a great place to start your discussion. Find it on the AMSA website at http://www.amsa.org/election/scorecard.cfm<br /><br /><span style="font-size:130%;">Questions to consider as you think about each candidate's plan:</span><br /><br />1) How does a private health insurance system work? What are the fundamental failings of such a system, and how might they be corrected with market incentives or industry regulation? What other models for health insurance exist, and would it be feasible to use these in America?<br /><br />2) Is health care a right? Do Americans have to choose between equality, efficacy, and efficiency in our health care system, or is there a way to get all three? Do the plans of either candidates offer substantial progress towards achieving this goal?<br /><br />3) Under McCain's Plan: What are the advantages to buying health insurance on an open market, across state lines? What are the disadvantages? How might this affect the system as a whole?<br /><br />4) Under Obama's Plan: Will healthy individuals purchase health insurance without mandates, or will they "free-ride" the system until they get sick, knowing they will not be denied coverage due to a pre-existing condition? What are the advantages and disadvantages to requiring mandates?<br /><br />5) What do the two plans have in common? Where are the areas of greatest disparity?<br /><br />6) Imagine you are running for president. How would your own health care platform differ from that of Senators Obama or McCain? How might your opponent criticize your plan, and how would you frame your argument to defend your plan to the American people?<br /><br /><span style="color: rgb(153, 0, 0);font-size:130%;" >Don't forget to vote!</span><br />...and as always, here's to your health!JRLDhttp://www.blogger.com/profile/04600844319585409807noreply@blogger.com3tag:blogger.com,1999:blog-4207451647415222161.post-77056440309969795882008-09-08T19:09:00.000-07:002008-09-08T20:12:17.071-07:00<span style="font-size:130%;"><span style="color: rgb(153, 0, 0);">SEPTEMBER Topic: Health Savings Accounts</span></span><br /><br />In elections all over the country, candidates are raving about Health Savings Accounts. But what are Health Savings Accounts, and are they really the silver bullet for American health care reform?<br /><br /><span style="font-size:130%;">Questions to Ponder</span><br /><br />1) In what ways is competition good for health care? In what ways is it bad?<br />2) Do Americans overuse health care? Is this overuse supply-driven (by doctors and hospitals) or demand driven (by patients)? Can this overuse be controlled by Health Savings Accounts?<br />3) In what ways do Health Savings Accounts affect the rest of the insurance market? What is the reason for the insurance function, and how can insurance markets fail?<br />4) What information do patients need in order to be rational, efficient consumers of health care services? What tools are available to help patients become better informed? What are the information problems and uncertainty intrinsic to health care?<br /><br /><span style="font-size:130%;">Background and Resources<br /><span style="font-size:85%;"><br /><a href="http://www.nytimes.com/2005/08/14/business/yourmoney/14health.html?_r=1&scp=5&sq=%22Health%20Savings%20Accounts%22&st=cse&oref=slogin">The Promise and Pitfalls of Health Savings Accounts</a><br /><br /><a href="http://online.wsj.com/article/SB121553704291136243.html">Wall Street Journal - To Your Health</a><br /><br /><a href="http://www.nytimes.com/2006/04/03/opinion/03hubbard.html?scp=19&sq=%22Health%20Savings%20Accounts%22&st=cse">NYT Op-Ed - The Health of a Nation</a><br /><br /><a href="http://www.nytimes.com/2006/02/03/opinion/03fri1.html?scp=20&sq=%22Health%20Savings%20Accounts%22&st=cse">NYT Editorial - The Lopsided Bush Health Plan</a><br /><br /><a href="http://www.kff.org/insurance/upload/7566.pdf">RAND Health Insurance Study</a><br /><br /></span><span style="font-size:85%;"><a href="http://www.amsa.org/uhc/HSAprimer.pdf">AMSA Health Savings Accounts Primer</a><br /><br /></span><span style="font-size:85%;"><a href="http://content.nejm.org/cgi/content/extract/353/12/1199">NEJM - Health Savings Accounts: The Ownership Society in Healthcare</a><br /><br /><a href="http://content.healthaffairs.org/cgi/reprint/14/2/260">Health Affairs - Medical Savings Accounts: Lessons from Singapore</a><br /><br /></span></span><span style="font-size:85%;"><br /><br /></span><span style="font-size:130%;"><span style="font-size:100%;"><br /></span></span>JRLDhttp://www.blogger.com/profile/04600844319585409807noreply@blogger.com1tag:blogger.com,1999:blog-4207451647415222161.post-71932064258130112512008-07-08T09:25:00.000-07:002008-07-16T08:57:50.874-07:00JULY Topic: Medicare Payment Cuts to PhysiciansJust before the Fourth of July recess, the House passed a bill to prevent Medicare a pay cut of 10.6% by a vote of 355 to 59. In the Senate, Republicans blocked efforts to take up the bill, so the cut took effect on July 1. But the Bush administration has delayed processing of new claims to give Congress time to come up with a compromise.<br /><br />Core Concepts (will open in new window):<br /><ul><li><a href="http://hpandapint.blogspot.com/2008_05_01_archive.html" target="new">Physician Reimbursement<br /></a></li><li><a href="http://hpandapint.blogspot.com/2008/05/provider-reimbursement.html" target="new">Provider Reimbursement</a></li><li><a href="http://hpandapint.blogspot.com/2008/05/medicare-structure.html" target="new">Medicare Structure</a><br /></li></ul><br />KaiserNetwork.org, 7/16.08<br /><a href="http://www.kaisernetwork.org/daily_reports/rep_hpolicy.cfm#53325"><b>Congress Overrides Veto of Medicare Bill To Delay Physician Payment Cut</b></a><br /><br />New York Times, 7/13/08<br /><a href="http://www.nytimes.com/2008/07/13/washington/13medicare.html?th&emc=th"><nyt_headline version="1.0" type=" "> Long-Term Fix Is Elusive in Medicare Payments</nyt_headline></a><br /><span style=";font-family:times new roman,times,sans serif;font-size:100%;" > Congress has blocked a cut in payments to doctors but has not solved the problem that caused the cut, experts say.</span><br /><br />KaiserNetwork.org, 7/10/08<br /><a href="http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=53221">Senate Votes 69-30 To Approve Legislation That Would Halt Medicare Physician Payment Cut</a><br /><br />New York Times, 7/7/08<br /><a href="http://www.nytimes.com/2008/07/07/health/policy/07medicare.html?ex=1216180800&en=44bae7ce4dbc726d&ei=5070&emc=eta1">Doctors Press Senate to Undo Medicare Cuts:</a><br /><span style="color: rgb(0, 0, 0);font-family:Times New Roman,Times,Serif;" >Ads by the American Medical Association blame Senate Republicans for a 10.6 percent cut in payments to doctors who care for older Americans. </span><br /><br />New York Times, 7/5/08<br /><a><span style="color: rgb(0, 0, 102);font-family:Times New Roman,Times,Serif;font-size:78%;" > <strong> </strong></span></a><span style="color: rgb(0, 0, 102);font-family:Times New Roman,Times,Serif;font-size:78%;" ><strong><a href="http://www.nytimes.com/2008/07/05/opinion/05sat2.html?ex=1216180800&en=cca706d3d5a2583f&ei=5070&emc=eta1" target="_blank"><span style="font-weight: normal;font-size:100%;" > The Senate Stalls on Medicare</span> </a> </strong> </span><br /><span style="color: rgb(0, 0, 0);font-family:Times New Roman,Times,Serif;" > A sensible new Medicare bill must pass so that Congress can wring subsidies from inefficient private Medicare plans.<br /><br />KaiserNetwork.org, 7/8/08<br /></span><a href="http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=3&DR_ID=53168">Medicare Physician Pay Patch Bill Might Gain Enough Votes for Cloture in Senate, Baucus Says</a><br /><br /><span style="font-weight: bold;">Questions to Ponder</span><br /><br />- How do you think physician payments should be set?<br /><br />- Should Medicare Advantage programs exist? Why or why not?<br /><br />- Why has no meaningful reform occurred regarding physician payments through Medicare?<br /><br />- Are medical students at your school informed about Medicare payments? Do they think what happens with Medicare will impact their future careers?Sylviahttp://www.blogger.com/profile/06325799042672079572noreply@blogger.com0tag:blogger.com,1999:blog-4207451647415222161.post-64097035099239195622008-06-08T12:40:00.000-07:002008-06-08T14:39:40.507-07:00JUNE TOPIC: How is Massachusetts Mandated Insurance Working?A study from the <a href="http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=688057"target='_blank'>Commonwealth Fund</a> that analyses mandated insurance in Massachusetts one year on.<br /><br />An article from the <a href="http://www.boston.com/business/articles/2008/05/31/mass_tab_for_private_sector_healthcare_rises/" target='_blank'>Boston Globe</a> about costs.<br /><br />- Do you think mandated insurance is the most cost-effective insurance system?<br /><br />- What do you think are the advantages and disadvantages of mandated insurance vs. Obama's plan vs. publicly funded insurance?Sylviahttp://www.blogger.com/profile/06325799042672079572noreply@blogger.com1tag:blogger.com,1999:blog-4207451647415222161.post-30028112789890548552008-05-13T14:46:00.000-07:002008-07-13T14:48:08.496-07:00Medicare Structure<span style="font-size:130%;"><span style="font-weight: bold;"></span></span><span style="font-weight: bold;">The Original Medicare: Parts A and B</span><br /><br />Part A covers hospital stays (including stays in a skilled nursing facility) if certain criteria are met. Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, Immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as lupron, and other outpatient medical treatments administered in a doctor's office. Medication administration is covered under Part B only if it is administered by the physician during an office visit. Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not taking Part B if not actively working.<br /><br /><span style="font-weight: bold;">Part C: Medicare Advantage plans</span><br /><br />With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). These programs were known as "Medicare+Choice" or "Part C" plans.<br /><br />Medicare has a standard benefit package that covers medically necessary care members can receive from nearly any hospital or doctor in the country. For people who choose to enroll in a Medicare private health plan, Medicare pays the private health plan a set amount every month for each member. Members may have to pay a monthly premium in addition to the Medicare Part B premium and generally pay a fixed amount (a copayment of $20, for example) every time they see a doctor.<br /><br />The private plans are required to offer a benefit package that is at least as good as Medicare’s, but they do not have to cover every benefit in the same way. Plans that pay less than Medicare for some benefits, like skilled nursing facility care, can balance their benefits package by offering lower copayments for doctor visits. Private plans get a hefty subsidy from the government for each beneficiary they enroll, and use some of the excess payments they receive to offer supplemental benefits.<br /><br /><span style="font-weight: bold;">Part D: Prescription Drug Plans</span><br /><br />Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are free to choose not to cover some drugs at all.<br /><br />Out-of-pocket costs<br /><br />Neither Part A nor Part B pays for all of a covered person's medical costs. The program contains premiums, deductibles and co-pays, which the covered individual must pay out-of-pocket. Some people may qualify to have other governmental programs (such as Medicaid) pay premiums and some or all of the costs associated with Medicare.<br />Part C and D plans may or may not charge premiums, at the programs' discretion. Part C plans may also choose to rebate a portion of the Part B premium to the member.<br /><br />Payment for Services<br /><br />Medicare contracts with regional insurance companies who process over one billion fee-for-service claims per year. In 2003, Medicare accounted for almost 13% of the entire federal budget. Based on the CMS projections, 33 cents of every dollar spent on health care in the U.S. is paid by Medicare and Medicaid (including State funding). Looked at from three different perspectives, 61 cents of every dollar spent on nursing homes, 47 cents of every dollar received by U.S. hospitals, and 27 cents of every dollar spent on physician services is funded by Medicare or Medicaid.<br /><br />For institutional care such as hospital and nursing home care, Medicare uses prospective payment systems. A prospective payment system is one in which the health care institution receives a set amount of money for each episode of care provided to a patient, regardless of the actual amount of care used. The actual allotment of funds is based on a list of diagnosis-related groups (DRG). The actual amount depends on the kind of diagnosis made at the hospital. There are some issues surrounding Medicare's use of DRGs because if the patient uses less care, the hospital gets to keep the remainder. This, in theory, should balance the costs for the hospital. However, if the patient uses more care, then the hospital has to cover its own losses. This results in the issue of "upcoding," when a physician makes a more severe diagnosis to hedge against accidental costs.<br /><br />Payment for physician services under Medicare has evolved since the program was created in 1965. Initially, Medicare compensated physicians based on the physician's charges, and allowed physicians to bill Medicare beneficiaries the amount in excess of Medicare's reimbursement. In 1975, annual increases in physician fees were limited by the Medicare Economic Index (MEI). The MEI was designed to measure changes in costs of physician's time and operating expenses, adjusted for changes in physician productivity. From 1984 to 1991, the yearly change in fees was determined by legislation. This was done because physician fees were rising faster than projected.Sylviahttp://www.blogger.com/profile/06325799042672079572noreply@blogger.com2tag:blogger.com,1999:blog-4207451647415222161.post-69857798397960907162008-05-13T14:43:00.000-07:002008-07-13T14:45:05.234-07:00Provider Reimbursement<span style="font-weight: bold;">Provider Reimbursement</span><br /><br />Before doctors can get paid, the hospitals and clinics (healthcare providers) where we work must receive reimbursement for the services they provide to patients. Providers can get either be reimbursed directly from the patient or indirectly from a third-party payer such as an insurance company or the government. Direct from patient payments usually take the form of co-payments and co-insurance (see primer # whatever). Indirect payments may be fee-for-service, budget, or capitation.<br /><br /><span style="font-weight: bold;">Fee-for-service</span><br />Just as individual physicians can be reimbursed per service they provide, so hospitals and clinics can bill insurance companies for each individual part of a patient’s care. This “a la carte” style of billing takes into account expenses such as hospital bed days, medications used, and professional time. Just as in physician FFS payment, FFS payments to providers gives an incentive to overproduce – to keep a patient in the hospital for an extra day, for instance.<br />In order to undermine the overproduction incentive, some insurers – such as Medicare – give a FFS payment dependent on the patient’s diagnosis on admission. This diagnosis-related-group (DRG) is less like an a la carte cafeteria and more like ordering a bundled entrée off a menu. The payment is based on the services usually required for a patient with that diagnosis. This gives providers an incentive to be efficient with the care they provide.<br /><br /><span style="font-weight: bold;">Budget</span><br />Global budgeting is a cost-control method of paying hospitals that gives a lump sum to pay for all patient services over a year. The idea is that hospitals only have a certain amount of money to spend on care. Problems with global budgeting arise when the hospital runs out of money before the end of the year, making them unable to provide services or necessitating a bail-out. It can also be difficult to determine how much to give for a hospital budget, as budgets are usually set based on previous year’s spending. This means more inefficient providers are rewarded for their ineptitude with more money, not given less in order to drive them to be efficient.<br /><br /><span style="font-weight: bold;">Capitation</span><br />Capitation is a way of paying providers that gives a fee per patient rather than a fee for service. Insurers give a provider a set sum to give care to one patient for one year. Any money the provider does not spend, they are allowed to keep. This exerts a cost-controlling force on providers. However, it also may induce providers to limit the number and types of services provided to it’s enrollees. It also gives an incentive to only attract the healthiest – and thereby cheapest – patients to their clinic. Risk adjustment counteracts this tendency to cream-skim by paying more money for patients who are sick or who are demographically likely to become sick. Risk adjustment can be a good tool to encourage providers to tailor services toSylviahttp://www.blogger.com/profile/06325799042672079572noreply@blogger.com0tag:blogger.com,1999:blog-4207451647415222161.post-83457885645007542222008-05-13T14:37:00.000-07:002008-07-13T14:39:31.316-07:00Physician Reimbursement<span style="font-weight: bold;">Physician Reimbursement<br /><br /></span>We all like that doctors get paid. However, beyond picking up their bi-weekly paycheck and grumbling about how many taxes have been taken out, many doctors don’t take time to ponder the economic theory behind different methods of physician reimbursement. This really is a shame, because financial incentives have been shown to drive physician behavior. Below I have covered three of the most common ways of paying doctors – salary, fee-for-service, and pay-for-performance – and how these methods can impact the way doctors practice medicine.<br /><br /><span style="font-weight: bold;">Salary</span><br />A salary is a fixed, regular payment made by an employer to an employee. In some ways a salary represents a good-faith agreement on the part of the employee to work a certain number of hours at or above a set level of productivity. In medicine, a salaried physician may agree to see a certain number of patients a day, or to be responsible for a patient list or population.<br />One criticism of salaries is that they give a perverse incentive for the employee to do as little work as is possible to do without getting fired or demoted. After all, the payment will not vary based on the productivity of the employee. In medicine, professional values such as hard work and service to the patient may supersede this perverse incentive. Peer pressure from physician partners can also override a salaried professional’s inclination to under-produce in his time at the office.<br /><br /><span style="font-weight: bold;">Fee-for-service</span><br />Whereas salaries do not increase according to physician productivity, under fee-for-service (FFS) reimbursement, only measurable production is rewarded. Physicians are paid individually for each appointment, test or procedure they undertake. This gives a strong incentive for physicians to optimize production in the time they spend in the office, which can increase their efficiency.<br />FFS causes problems when physicians shift their practice toward reimbursable services and begin to provide medically unnecessary care – this can lead to large amounts of inefficient care. FFS payment has helped create a culture of medical practice in America that is largely dominated by procedures, prescriptions and tests. Medicare pays on a FFS basis.<br /><br /><span style="font-weight: bold;">Pay-for-performance</span><br />Pay for performance (P4P) is a relatively new movement in physician reimbursement that attempts to pay physicians more for high quality, appropriate care. This type of payment is tied directly into problems with measuring quality in medical care. P4P models based on patient outcomes give an incentive for physicians to take on only the healthiest patients and simplest cases. P4P models based on evidence-based procedures (such as a yearly retina screen for diabetics) may shift care away from individualized services toward those that are reimbursed.Sylviahttp://www.blogger.com/profile/06325799042672079572noreply@blogger.com0