Reporter finds conflict in N.Y. reform effort
Filed under: Conflicts of interest, Health care reform
A Syracuse University professor charged with reforming health insurance reimbursements gave up her position on an insurance company’s board on Friday after James T. Mulder, a reporter with The (Syracuse, N.Y.) Post-Standard, started looking into her ties.
Deborah Freund, a health economist and professor at Syracuse University, is overseeing a project intended to reform the health insurance system and eliminate conflicts of interest.
However, she has been on the board of Excellus since 2004 and received more than $61,000 from the health insurance company last year.
Freund oversees “FAIR Health Inc., a New York City-based nonprofit that is supposed to come up with a new, fair reimbursement system that will be used by insurers nationwide.” The project is funded by settlements from 13 insurers that used reimbursement data that rigged the system “to benefit insurers at the expense of consumers and doctors.”
At a news conference last year, [state Attorney General Andrew] Cuomo said the FAIR Health project will bring “ … transparency, accountability and fairness to a broken reimbursement system …”
Despite earlier statements from Excellus, the university and Cuomo’s office that Freund’s board position did not post a conflict of interest, a view not shared by consumer advocates, the professor resigned from the board Friday afternoon after Mulder spend several days looking into the situation.
Mental health parity law implementation evolves
Filed under: Government, Health care reform, Hot Health Headline
Writing for Kaiser Health News and The Washington Post, Sandra Boodman considers the effect that the American mental health parity law has had since it went into effect on Jan. 1.
The law applies to about 140 million Americans, Boodman writes, most of whom are insured by employers with more than 50 employees. For qualifying groups, “Higher deductibles, steeper co-pays and other restrictions are no longer allowed for mental health and substance abuse treatment.” It doesn’t apply to individual policies and doesn’t require employers to offer mental health coverage of any kind.
There are still questions about the implementation of the law, many of which are addressed in the Obama administration’s implementation plan (PDF), which should take effect on July 1.
Officials of key business and insurance industry groups said they were displeased that the regulations were “more expansive” than they believe lawmakers intended. Mental health advocates applauded the rules, which they said would help ensure that Americans battling schizophrenia, for example, receive the same level of care provided to those facing leukemia.
Federal officials estimate that complying with the law will increase premiums nationwide by four-tenths of 1 percent, or about $25.6 billion over 10 years. Employers are free to drop mental health and substance abuse coverage and are allowed to manage claims to determine if treatment is medically necessary, just as they do now for physical ailments, but the standards can no longer be more stringent. Plans are also allowed to exclude treatment for certain illnesses, such as eating disorders, as long as state law does not mandate coverage. There is also an escape hatch: Plans that can prove that their costs increased by more than 2 percent in the first year can file for an exemption.
Fortunately, it looks like that sort of cost increase will be rare, based on research that shows similar rules improved access without increasing cost.
For some background on the mental health parity law, check out MIWatch.org.
Health care summit streaming live
President Barack Obama is hosting a bipartisan meeting to discuss health care reform. The meeting, from 10 a.m. until 4 p.m. is being streamed live.
- Obama’s proposal
- Republican ideas included in Obama’s proposal
- Solutions to health care from the GOP
- Bipartisan meeting
Analysis reveals who hired health care lobbyists
Filed under: Government, Health care reform, Public records
The Center for Public Integrity has put together an interesting analysis and graph of what interests were lobbying on health care reform in Congress in 2009.
Information to create the chart is drawn from an analysis of Senate lobbying disclosure forms. The analysis found that “more than 1,750 companies and organizations hired about 4,525 lobbyists — eight for each member of Congress — to influence health reform bills in 2009.”
Trade, advocacy and professional organizations led the lobbying push, with hospitals, insurance companies and manufacturers behind them.
Some interesting tidbits:
- AARP deployed 56 in-house lobbyists and two from outside firms
- The U.S. Chamber of Commerce had 47 lobbyists, all but eight from outside firms
- The American Medical Association had 33, 11 from outside firms.
- Some unexpected organizations, including Americans for the Arts and the International Association of Amusement Parks and Attractions, also had lobbyists trying to influence health care legislation.
Lieberman: Media bought into heart docs’ fight
Filed under: Health care reform, Health journalism, Hot Health Headline
Using one-sided sentences published by newspapers nationwide as evidence, AHCJ Immediate Past President Trudy Lieberman takes her media peers to task on CJR.com for blindly advancing the agenda of the American College of Cardiology in their push against Medicare reimbursement cuts.
The ACC aggressively fought what Lieberman describes as “a new Medicare rule, which took effect January 1, that cut projected total revenues for cardiologists by 13 percent on average over four years while increasing the revenue of internists, family doctors, and general practitioners.” Lieberman writes that the rule change will effectively put more money toward much-needed primary care specializations and that it was widely mischaracterized in the press, thanks to ACC’s machinations. Lieberman:
… for the most part (news articles) passed along the cardiologists’ complaints, threats, and warnings without any hint that there was another side to the story. Between the slanted newspaper articles and audio news releases from the ACC, millions of Americans learned that the incomes of heart doctors, which can be upwards of $400,000, could take a hit.
Academics: Media added to reform confusion
Filed under: Health care reform, Health data, Hot Health Headline, Member news
Health News Florida’s Carol Gentry talked to journalism professors at three major Florida universities about the effect of media coverage on public perception of health care reform. The trio suggested that the media muddied the issue by focusing coverage on the political horse-race aspects while neglecting to invest the time necessary to fully explain the proposed legislation’s finer details.
In a column for AHCJ, Trudy Lieberman, the organization’s immediate past president has discussed some of the same shortcomings of health reform coverage. The academics say this is nothing new – many of the same issues surfaced during Clinton’s health reform push in the early ’90s, but say today’s fragmented media environment and 24-hour news cycle have certainly exacerbated matters.
[Kim Walsh-Childers, University of Florida journalism professor] said many Americans get their information from talk radio or blogs, “which are far less likely to provide balanced, complete information than are traditional news outlets, especially newspapers.”
“Even those who read newspapers may be getting far more information about the political strategies (of) the various stakeholders … than they are about what those proposals actually would mean for the average family,” Walsh-Childers continued.
Walsh-Childers praised NPR and The New York Times for their more thoughtful reform coverage, and said layoffs of experienced health reporters had likely weakened coverage at many outlets.
Gentry also cited surveys conducted by the Kaiser Family Foundation which found that peoples’ opinions of reform changed when they were better informed of the bills’ actual components.
Surveyors found that while a majority said they were opposed to the legislation, support grew markedly when survey participants found out the major parts of the plan.
Three-fourths became more favorable when they heard about tax credits for small businesses and two-thirds liked what they heard about health exchanges, constraints on health insurers and plugging the Medicare prescription-drug “doughnut hole.”
Related
More columns by Lieberman about coverage of health reform:
- Putting a human face on McCain, Obama health plans
- Look for opportunities to localize the debate on national health reform
- If candidates won’t focus on aging issues, journalists better
- Candidates’ health reform language needs closer scrutiny, definition
- Journalists must do better to inform, educate public
Health reform and the Supreme Court
Filed under: Government, Health care reform, Health data
Sarasota Health News‘ David Gulliver and Health News Florida’s Mary Jo Melone considered exactly how last Thursday’s Supreme Court ruling on campaign contributions by corporations would impact the health care lobby and the health reform debate. Their most interesting angle? That health care companies have already spent such gigantic sums of money on lobbying (more than $2.2 billion in 2008 and 2009) that the ruling won’t have the same impact on health as it will on other industries. In other words, the medical industry has already had the volume on the lobbying amp cranked to 10 for some time now, and it’s just not possible to ratchet it up any higher.
Gulliver and Melone on exactly what has changed in theory:
Until now, companies could not spend their own money directly on political advertising. They had to create political action committees, or a shadowy type of nonprofit known as a 527 organization. Then those groups could raise money from donors to pay for advertisements. For PACs, those donations are limited under federal law to $5000 per person per year.
In practice, the impact is less clear. Even under the previous system, those with money found ways to use it with impunity. It’ll be a more straightforward process now but, especially in health care, may not lead to huge changes in the money being spent. According to one school of thought, the biggest change will be in the use of explicit anti-candidate advertising threats as a metaphorical club during negotiations.
NOTE: It’s important to remember that, in a companion decision, the court upheld the transparency requirements that accompany these political donations. If you’re interested in tracking the changes in donations post-decision, head over to OpenSecrets.org, where they have a post explaining exactly how to use their tools to do so.
As for immediate impact, the reporters quote several experts who seem to think that unrestrained spending won’t transform the health care reform debate, partly because it’s already been so thoroughly transformed by other factors.
(Brad Ashwell of Florida Public Interest Research Group) said the legislative health-reform package pending in Congress is already “pretty moderate,” and it’s not likely to get more consumer-friendly now that business interests “can go straight to their treasuries.”
Even before the Supreme Court ruling, chances of helping Florida’s 3.8 million uninsured were looking increasingly sketchy, with a special-election loss that cost Democrats a crucial seat in the U.S. Senate this week. The only quick route to passage was for the House to accept the version of the legislative package that barely passed in the Senate on Christmas Eve, and House Speaker Nancy Pelosi announced Thursday she doesn’t have the votes to pull it off.
Denmark sees results from electronic records
In The New York Times, Sindya Bhanoo examines Denmark, a country which has adopted health information technology to a high degree. Bhanoo finds that, while Denmark is in some ways an exceptional case, it can also provide a few principles to guide America’s proposed adoption of the same technology, chief among those being patience, persistence and a gradual pace.
Photo by juhansonin via Flickr
While Denmark does not have a standardized electronic medical records system, it does have a national patient registry and a wealth of examples of hospitals adopting innovations such as telemedicine (including remote monitoring and diagnosis), paperless prescriptions and electronic modeling. “Virtually all” Danish primary care physicians use electronic records, Bhanhoo writes, and nearly half of Danish hospitals have adopted them as well. To put those numbers in perspective, Bhanoo mentions that “about 10 percent of American hospitals and about 17 percent of American doctors use electronic records.”
Bhanoo writes that while the decade-long Danish push into HIT has not been perfect – it’s fragmented and hampered by budget constraints – it has achieved measurable success.
Several studies, including one to be published later this month by the Commonwealth Fund, conclude that the Danish information system is the most efficient in the world, saving doctors an average of 50 minutes a day in administrative work. And a 2008 report from the Healthcare Information and Management Systems Society estimated that electronic record keeping saved Denmark’s health system as much as $120 million a year.
In the end, Bhanoo concludes that while these same successes will be harder to achieve in the significantly larger and more complex American system, experts believe that a modified Danish roadmap should be able to produce results in the United States.
How health reform lost popular support
Filed under: Government, Health care reform, Health policy
Kaiser Health News staff writers, including Jordan Rau, Mary Agnes Carey, Julie Appleby and Phil Galewitz, teamed up to figure out why Americans are so disenchanted with health care reform. After talking to an analyst who admitted that politicians “can do everything right and still fail in health reform,” the reporters set out to figure out what, if anything, went wrong.
The reporters divided the administration’s missteps (and, to a lesser degree, those of lawmakers) into four categories: helping individuals understand how reform tangibly benefited them, threatening Medicare, proposing a number of confusing tax increases, and the lengthy and frustrated deal-making process that preceded the reform bills now under consideration.
Myth surrounds reform’s ‘Safeway Amendment’
Filed under: Government, Health care reform, Health policy
Throughout the health care reform process, politicians have held up Safeway’s health incentive program as a model for future government health plans. The supermarket chain’s program requires employees who fail basic health screenings for blood pressure, weight, and cholesterol to pay higher health insurance premiums. 
Safeway maintains that this policy encourages its employees to make healthy lifestyle changes to in turn lower their health care costs. The Washington Post’s David Hilzenrath looked into the grocer’s impact on proposed health reform plans. Hilzenrath reports on how misconceptions about Safeway’s wellness program could impact public health policy in the U.S. Senate’s proposed Safeway Amendment.
Under a regulation advanced during George W. Bush’s administration, incentives conditioned on meeting wellness targets are limited to 20 percent of the premium – including employer and employee contributions to the premium. The Safeway Amendment would allow employers to increase the stakes to 30 percent, and it would give federal officials license to raise the limit to 50 percent. It would also allow insurers to use the same approach – initially in 10 states and potentially in others.
Employers and insurers would be required to make exceptions for people with extenuating medical circumstances.
Supporters of the amendment maintain that it will encourage private-sector employees to monitor and improve their health. Dissenting organizations, including the American Heart Association and the American Cancer Society, suggest that the legislation will unhinge a central tenet of health reform: That an individual’s health status will no longer impact premiums.
Safeway credits its internal health plan for keeping the company’s health care costs nearly steady between 2005 and 2009. An external survey of 1,700 employers revealed that companies’ health care costs increased by 30 percent in the same time period, on average.
Hilzenrath reports that “a review of Safeway documents and interviews with company officials show that the company did not keep health-care costs flat for four years. Those costs did drop in 2006 – by 12.5 percent. That was when the company overhauled its benefits, according to Safeway Senior Vice President Ken Shachmut.”
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