Diet and Nutrition. Natural Health, and Healthy Living

The following is a guest post from Rushika Fernandopulle, MD, MPP,

Co-Founder of Renaissance Health

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In light of all the discussion about the Economic Recovery Plan and the privacy provisions in the HIT Title, I thought it might be helpful to provide a consumer advocate’s view. The National Partnership for Women & Families leads a coalition of consumer, patient, and labor groups, the Consumer Partnership for eHealth (CPeH). The organizations in this coalition are working to advance HIT adoption, because we know that achieving better coordinated, higher quality health care demands the integration of new technologies into the health care delivery system.

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Only a few months ago, Goldman Sachs was touted as an incredible bastion of strength in the face of the credit crunch. Sure some other institutions might have been suffering, but Goldman was savvy enough to earn record profits in 2007. The average bonus was a whopping $600,000 per employee. Then very suddenly Goldman and pretty much the whole industry collapsed. The federal government has stepped in, and a partial nationalization of the financial industry is underway. That’s not the free market, it’s socialism.

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My take: Pre-certification, mandating good behavior, Power 81) A reader writes: "Physician orders a CT scan for patient. The powers that be at [the insurance company], refuse to pre-certify the request and deny the test. Next, patient goes to the emergency room and the ER physician orders the CT scan. Now, [the insurance company] has to pay ER fees, ER physician fee, radiologist fee and any other costs. The overall cost is now probably 1-2 thousand dollars instead of a couple hundred bucks, if the original CT request had been pre-certified.
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My take: Medicare payment cuts avertedThe Senate passed the bill blocking a 10.6 percent Medicare payment cut today by a veto-proof margin of 69-30.

A hat tip to the Democrats who played this scenario balls-out. They took the initiative after the bill passed so decisively in the House. The Republicans were snookered, and in today's repeat vote, it appeared that 8 of them flipped their vote. Kudos to the lobbies that strong-armed them. They were placed in a no-win situation of trying to defend the insurance companies against physicians and seniors.
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Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron's and Institutional Investor. She is the author of Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much, an examination of the economic forces driving the healthcare system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite healthcare reads, where this piece first appeared.

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My take: Medicare, balance billing, me, op-edsSome pre-holiday takes readers have asked me about.

Here's my take on . . .

1) . . . the Medicare cuts:
Next week is going to be an interesting week. My guess is that the Senate will hammer out something to avoid the 10% physician payment cuts. The question is, will the Republicans take money away from the Medicare Advantage plans? And will the President veto the bill? I think the answers will be yes and maybe. The Democrats have grown some balls and will play tough.
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Charlie Baker is the president and CEO of Harvard Pilgrim Health Care, Inc., a nonprofit health plan that covers more than 1 million New Englanders. Baker blogs regularly at Let's Talk Health Care.

One of the reasons the operating model in health care doesn’t change much over time is pretty simple: most of the people who think about it, write about it, work in it and study it have trouble seeing the model any differently than they see it today. I was struck, therefore, by Hebrew Senior Life’s Len Fishman the other day when he and I served on a panel at the 30th annual meeting of the Massachusetts Health Data Consortium. We were told to discuss health care 30 years from now — me from the plan perspective, and Len from the long term care perspective. I went pretty far out there in my remarks, imagining, among other things, a world in which there were no health plans at all(!). Len did too. His presentation on the future of long term care could not have looked more different than what we have today. He literally re-imagined the whole thing. It was startling — and refreshing.

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Reader take: Going green in the physician's officeThe following is a reader take by an anonymous physician.

Pharmaceutical companies could use a little greening. Consider the 5 inch by 5 inch tri-fold wrapper for a 1.5 gram sachet of the latest antibiotic cream, or how about the individually wrapped pills of the latest antihistamine to go over the counter. Does a can of formula need to go into a cardboard box? How about the reprints and other drug propaganda that reps leave in our offices when they pay a visit – from plastic lung models to stuffed animals with their latest slogan? What can an office do with expired drug samples?
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My take: Mid-levels, health consultants, blogging1) A reader writes: "I guess I'm just looking for an intellectually honest assessment of what is wrong with the practice model of one or two MDs supervising several mid-levels so the MDs are free to spend more of their time on the intellectually taxing cases."

There is nothing wrong with that model. Mid-levels play a valuable role in primary care delivery, and moreso in the future, with the ranks of primary care MDs dwindling.
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