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.
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
Health care bill moves forward
Following the Senate vote on the health care bill, reporters have rushed to cover the latest developments. Here is just a bit of the coverage:
Ricardo Alonso-Zaldivar and Erica Warner of The Associated Press have a point-by-point comparison of the Senate and House health care bills. Werner also has an interesting look at the winners and losers in the bill, including the residents of Libby, Mont., many of whom suffer from asbestos-related illnesses from a now-closed mineral mining operation.
On The Wall Street Journal’s health blog, Jacob Goldstein reports on the Congressional Budget Office’s estimates on the Senate bill with the “public option lite” - with private plans overseen by a government agency.
Reuters’ Donna Smith offers an overview of the Senate health care bill in a Q&A format.
Scott Hensley of NPR’s Shots blog notes the weekend’s key development that led to the bill moving forward and he looks ahead to reconciliation.
In a piece that appears in USA Today, Phil Galewitz of Kaiser Health News points out that mandates, such as requiring all Americans to have health insurance, do not guarantee compliance. His article explains the mandate and the penalties for those who choose to go uninsured.
In the Los Angeles Times, Kim Geiger and James Oliphant also look at the mandate: why its in the bill, how it can cover people with expensive illnesses and “age rating.”
Plenty more coverage is emerging by the minute. Here is the bill.
Pay for the person - not the procedures
When people talk about health reform it’s often shorthand for covering the uninsured. But improving access without tackling costs is a recipe for a fiscal crackup.
Just take a look at Massachusetts, a pioneer in universal coverage, where the cost of medical care is growing at more than 8 percent a year. Ballooning subsidies for coverage of the poor are one problem. Another is heavy use of high-priced hospital care.
The Boston Globe reports on the recommendations of a state commission to pay doctors and hospitals a set amount for each person’s care for a year. (Read the report here.)
Some might call it capitation redux. The payment approach, once popular with managed care, aims to curb incentives for doctors and hospitals to do more to get paid more. Previous attempts at capitation were too stingy and inflexible and remain worries this time around, critics say.
On the national front, the cost of health reform is moving to the fore, galvanizing opposition to the plans advanced in Congress. The Washington Post reports that the head of the Congressional Budget Office “delivered a devastating assessment” of the fiscal consequences of the proposals because they don’t do enough contain the fast-growing costs of government health programs.
Where’s the money for health reform?
If there ever was a time to remind health journalists to follow the money, it’s now.
President Obama is back in campaign mode, barnstorming the country to win support for health-care reform. The details and fate of the overhaul remain uncertain, but it’s clear any steps toward universal coverage will mean big bucks — at least $1 trillion over 10 years.
How to pay the bill without increasing the federal deficit, as Obama has pledged? A combination of tax hikes and cost cuts.
Team Obama is already planning for reductions in payments to hospitals, private insurers and drugmakers. For more details, see the video below and the White House blog’s post on Obama’s weekly radio address.
But the real action is looming over how to get more cash into the health system. A federal tax on employer-sponsored health benefits, opposed by Obama during his run for president, is under serious consideration in the Senate, the Washington Post reports.
That approach, supported by some economists as a way to manage health costs, could be political suicide. “Taxing benefits would be a disaster,” Democratic pollster Celinda Lake tells the Post. “You have no idea how strongly this is going to backfire if we do it.”
Senate committee holds health care reform hearing
Senate Finance Committee Chairman Max Baucus (D-Mt.) and Sen. Chuck Grassley (R-Iowa) are holding the second of three conversations on reforming health care. CSPAN is streaming the hearing.
More than a dozen representatives from The Heritage Foundation, AARP, Families USA, the Kaiser Foundation, America’s Health Insurance plan and other organizations are expected to offer their opinions on how best to expand health care coverage & programs.
Op-ed: Obama’s quality metrics could be dangerous
On the Wall Street Journal’s Op-Ed page, Jerome Groopman and Pamela Hartzband cite the shortcomings of a quality metric-based system in Massachusetts and describe various misguided quality metrics. Groopman and Hartzband are both on the staff of Beth Israel Deaconess Medical Center in Boston and on the faculty of Harvard Medical School.
Initially, the quality improvement initiatives focused on patient safety and public-health measures. The hospital was seen as a large factory where systems needed to be standardized to prevent avoidable errors. A shocking degree of sloppiness existed with respect to hand washing, for example, and this largely has been remedied with implementation of standardized protocols. Similarly, the risk of infection when inserting an intravenous catheter has fallen sharply since doctors and nurses now abide by guidelines. Buoyed by these successes, governmental and private insurance regulators now have overreached. They’ve turned clinical guidelines for complex diseases into iron-clad rules, to deleterious effect.
Groopman and Hartzband cite several examples of regulations later proven questionable or even harmful, including the monitoring of ICU patients’ blood-sugar levels, the provision of statins to patients with kidney failure, and the monitoring of blood sugar in certain diabetics.
These and other recent examples show why rigid and punitive rules to broadly standardize care for all patients often break down. Human beings are not uniform in their biology. A disease with many effects on multiple organs, like diabetes, acts differently in different people. Medicine is an imperfect science, and its study is also imperfect. Information evolves and changes. Rather than rigidity, flexibility is appropriate in applying evidence from clinical trials. To that end, a good doctor exercises sound clinical judgment by consulting expert guidelines and assessing ongoing research, but then decides what is quality care for the individual patient. And what is best sometimes deviates from the norms.
Groopman and Hartzband cite studies showing that quality metrics had “had no relationship to the actual complications or clinical outcomes” of hip and knee replacement patients at 260 hospitals in 38 states and that, in 5,000 patients in 91 hospitals “the application of most federal quality process measures did not change mortality from heart failure.”
Sounds like it could be fodder for discussion at the “Medical effectiveness: Is there a NICE in U.S. future?” panel at Health Journalism 2009 on Saturday morning.
Moon on Medicare reform, supplmental insurance
As part of her Excluded Voices series in the Columbia Journalism Review, Trudy Lieberman, president of AHCJ’s board of directors, talks to medicare expert Marilyn Moon about the program’s weaknesses and about proposed reforms to the system. Moon pushes for a simplified deductible system, says supplemental insurance is a major concern for subscribers and calls private vouchers a “hail Mary pass.”
Moon offers a sober assessment of Medicare’s financial status, saying that many reformers operate under the implicit assumption that there are inefficiencies in the system that may not actually be present. In the end, reforms can’t escape the fundamental fact that you can’t lower taxpayers’ costs without increasing those of Medicare users.
“The public also needs to realize that refusing to insure certain tests and treatments that do not work is a good approach, not a bad one as some critics have charged,” Moon said.
Lieberman asked Moon what the “biggest risk faced by people now on Medicare” was.
The gaps in Medicare’s benefit package mean that anyone who can afford to will seek supplemental coverage. That coverage is expensive and often not a very good deal. When people buy what’s called “Medigap” insurance, on average they may be getting back only seventy-five cents worth of health care for every dollar they spend. Administrative costs are also high. But going without such coverage is risky since the basic Medicare package has no catastrophic protection for those with very high expenses.
Webcast of regional White House forum on reform
The third regional forum about health care reform is being held today in Des Moines, Iowa. It’s streaming live:
Read more about health care reform.
Malpractice reform joins health system debate
Erica Werner of The Associated Press reports that Ezekiel Emanuel, a key adviser on health issues to President Obama and brother of White House chief of staff Rahm Emanuel, offered some hints recently about the role of malpractice lawsuit reform in the debate over changes to the country’s health care system.
Ezekiel Emanuel
At a meeting of the American Medical Association, Ezekiel Emanuel said:
“I’m not going to give you any details because I can’t. I just can tell you I’ve been thinking long and hard about that,” Emanuel, an oncologist and the brother of White House chief of staff Rahm Emanuel, told the doctors when asked about malpractice lawsuit reform. “It hasn’t gone unnoticed. So stay tuned.”
Mary Ann Geier, organizer of Health Camp Philadelphia, posted on Twitter that she wonders what the hidden agenda is and whether it might not be incompatible with true reform. She says it’s something the average person can’t figure out. Reporters, what can you tell us?
Senate Finance Committee Chairman Max Baucus, D-Mont., has proposed developing “alternate litigation models,” similar to proposals offered by Obama and Hillary Clinton.
Sen. Ron Wyden, D-Ore., says malpractice reforms are key to overhauling the health care system.
“I think it’s an essential piece for there to be enduring reform, reform that will stick and will get a significant bipartisan vote in the United States Senate,” Wyden said.
Perhaps Wyden will expand on those comments when he speaks at Health Journalism 2009 on April 17.
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Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
- Shortened Lives: How location, lifestyle affect health
- Covering a complex story for the long haul
- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
