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Where have all the doctors gone? What physician supply means for health reform

The good news that was packaged in the Patient Protection and Affordable Care Act (PPACA), that is, health reform, was that millions of uninsured Americans would receive health insurance coverage through the Medicaid program. But insurance doesn’t equal access; there’s a limiting factor that’s a formidable obstacle in many of these millions of newly-insured people getting care: the physician supply in the U.S., which varies from region to region of the U.S. There’s both a quantitative aspect to this challenge along with a qualitative one. The U.S. has long had a maldistribution of physicians in both urban cores and rural towns; that’s the quantitative challenge.

 

The health IT talent shortage could slow HIT adoption in U.S. health care

For hospital CIOs, 2011 and 2012 are all about achieving meaningful use, focusing on clinical systems, safe-keeping health information, and staying financially healthy as an organization.  These insights are brought to you by the 22nd Annual HIMSS Leadership Survey, sponsored by Citrix. This survey has become the most important snapshot of health CIOs’ priorities looking ahead. This year’s survey results, unveiled week at HIMSS 2011 in Orlando, held some important findings. While achieving meaningful use is the top IT priority for the next two years (with 81% of organizations believing they’ll quality for MU in 2011 or 2012), clinical systems implementation and

 

The Connected Patient: some forces converging in the market, but barriers remain

Remote health monitoring, which enables people to track health and daily living metrics when they are in one place and communicate those measures to another node via some communications platform, is not a new concept. Telehealth, telemedicine, consumer-facing health electronics like USB-ported blood pressure monitors, and some mobile apps can all fall under the broad umbrella of remote health monitoring. There are strong market forces converging to enable health citizens to connect to their providers, institutions, payors, health coaches, caregivers, and each other. Still, a balanced look under the remote health monitoring hood reminds us that old saw taught to me by colleagues

 

Robert Reich connects the dots between the macroeconomy, angst, politics and health care costs

“I’m not a class warrior. I’m a class worrier,” Robert Reich told a standing-room only crowd of thousands of health IT geeks as he delivered the first keynote address of the annual meeting of HIMSS, the Healthcare Information Management and Systems Society. This year’s crowd will have reached about 31,000 people interested in health information technology’s transformative role in health care. The 31K represents an 18% increase in attendance from last year’s crowd. The HIMSS economy is strong. Robert Reich warns, however, that the U.S. macroeconomy is far from healthy…and health care costs will be a long-term threat to the

 

Don’t underestimate the costs of adopting health IT

Mature users of electronic health records bear many scars and learnings, having been through the first several rungs of the health information technology (HIT) adoption ladder. A few of these lessons for HIT adoption success… Implementing EMRs is a strategic and not just an IT-department initiative. HIT adoption requires top-down commitment and engagement. It takes longer and costs more than the planners of systems expect. During transition to an EMR, hospitals see an 80% “spike” (increase) in IT operating expenses — directly impacting the hospital’s overall operating budget as much as 200 basis points or more. There is evidence that those spikes

 

The Personal Health Economy for Americans in 2011

41% of Americans had problems getting a good paying job or raise in pay in the economic downturn in the U.S. 1 in 3 lost money in the stock market, had work hours cut or a pay cut. And, 31% had problems paying for gas and health care. 85% of uninsured people under 65 put off needed health care because of cost. In the past 12 months, families in the U.S. have faced multiple challenges with jobs, health, gas and food — challenges all bound up in the economic downturn in the U.S. 1 in 4 Americans report problems paying medical bills.

 

U.S. employers put health care cost containment at the top of reform priorities

1 in 5 among all U.S. employers (22%) would likely drop health insurance coverage and let workers buy a plan through a health insurance exchange. However, most employers would expand wellness programs driven by incentives in health reform. Employers’ perspectives on the Affordable Care Act/health reform are mixed, according to a survey conducted by the Midwest Business Group on Health, co-sponsored by the National Business Coalition on Health, Business Insurance and Workforce Management. Not surprisingly, these views vary by whether the firm is large (>500 employees) or small. More large employers support the creation of Health Insurance Exchanges and would expand wellness services;

 

The growing costs of health scuttle Boomers’ retirement plans

As household incomes in the U.S. have been, at best, stagnating in the past several years, the cost of health insurance premiums rose three times faster between 2003 and 2009. By 2015, the average premium for a family of four will reach nearly $18,000, according to The Commonwealth Fund. State Trends in Premiums and Deductibles, 2003-2009: How Building on the Affordable Care Act Will Help Stem the Tide of Rising Costs and Eroding Benefits from the Fund calculates that deductibles per insured person in the U.S. increased an average of 77% between 2003-09. In a related analysis, the Fund forecasts the

 

What health care IT holds for 2011: politics vs. market realities

The one issue in health politics that’s got bipartisan support is health care IT. While Republicans in the House may try to pick away parts of the Affordable Care Act, the HITECH Act — part of the 2009 stimulus package formally known as the American Recovery and Reinvestment Act — will stay intact, according to most industry analysts (including me). However, political agreement doesn’t equal market adoption. So forecasting what 2011 will mean for health information technology requires some deeper analysis of additional issues. For today’s Health Populi, take a look at my annual health IT forecast in California HealthCare Foundation‘s

 

The States’ fiscal crisis and health care: a day of reckoning for Medicaid before 2014?

It will be A Day of Reckoning, 60 Minutes, the CBS News weekly program, called it. This is the impending economic collapse of U.S. state economies, caused by over-borrowing, pension accounting, lower tax revenues during the recession, expanding services, and Next to the housing collapse of the past few years, this may be the largest threat to the American economy, according to Meredith Whitney, a Wall Street analyst quoted in the story. Chris Christie, Governor of New Jersey, says this is, “not an income problem, it’s a benefit problem.” When we think benefits and States, we think health care — specifically,

 

1 in 2 employers will continue to offer health insurance even if HIEs are competitive in 2014

Just over one-half of U.S. employers plan to maintain their health plans in 2014 even if health insurance exchanges (HIEs) offer competitive priced health plans for individual employee health coverage, according to a survey of 1,400 employers by Willis and Diamond Management & Technology Consultants. 1 in 3 employers is not sure whether they’ll maintain their own health plan or shift employees toward an HIE. The Health Care Reform Survey 2010 measured U.S. employers’ knowledge of the Affordable Care Act (ACA) and its expected impact on employers’ benefits. 9 in 10 employers (88%) believe that ACA will increase the costs of the health plans with

 

Medicaid, the new-new health plan – is it ready for prime-time?

“The impending Medicaid expansion will be the single biggest change in the program since its inception in 1965,” according to an analysis in the New England Journal of Medicine dated November 24, 2010. The Patient Protection and Affordable Care Act (PPACA, or ACA for short) will newly-insure 32 million Americans through dual strategies of (1) mandating uninsured people to buy into a health plan, via subsidies and health insurance exchanges; and, (2) expanding Medicaid to cover uninsured people with lower incomes. The CBO estimates that each of these tactics will add 16 million, for the total of 32 million people entering insurance plans

 

What prescription drug plans and health reform mean for personalized medicine

Prescription drug formularies are getting more complex to drive cost-savings as well as promote adherence to drug regimens, as told by the data in the 2010-2011 Prescription Drug Benefit Cost and Plan Design Report, sponsored by Takeda Pharmaceuticals NA. The average rate of drug cost increases is 6.3%, compared to 4.4% in the 2009-2010 survey — the lowest rate of increase since this survey was launched. A key part of the story of the new value-based benefit design is told by the co-payment differentials for Rx drugs, shown in the chart. Health consumers who have three-tiered prescription drug insurance face an

 

Seniors Are Happy With Rx Plans, Five Years After Part D Begins

Contrary to stereotypes, older people can adapt, learn, and use new products and services. The introduction of Medicare Part D five years ago was an experiment in public policy, with some policymakers fretting about seniors’ ability to navigate a new system. It appears Medicare Part D is a hit, and people are working well with it across gender, age cohorts, incomes (from very low to upper-income strata), educational levels, and especially very sick and disabled people. Among all seniors, 90% have prescription drug coverage. 61% of U.S. adults 65 and over have a Medicare prescription drug plan, 16% are covered by an employer-sponsored

 

The Other Half Struggles for Health Care in the Great Recession

There are two faces of America in The Great Recession: one is doing pretty well, thank you very much; the other is losing ground, and a lot of it. One Recession, Two Americas from the Pew Research Center is a survey of Americans’ home economics 30 months since the start of the recession which began in December 2007. The recession technically ended in June 2009, according to the National Bureau of Economic Research (NBER). One year after that ‘technical’ end, though, it appears about 1 in 2 Americans haven’t gotten the memo. Some of the Pew’s survey results appear in the chart. See the

 

No relief: medical costs will increase by double-digits again in 2011

Medical costs will grow between 10% and 11% in 2011, depending on whether an enrollee is opting for a PPO (11%), a POS (11.2%) or an HMO plan (10.2%). These growth rates are similar to 2010 increases, with the largest percentage growth projected for point-of-service plans from 10.6% in 2010 to 11.2% next year. These cost increases are roughly eight-times inflation in the consumer price index (CPI), gauged at 1.2% in July 2010 for urban consumers. The 2011 Segal Health Plan Cost Trend Survey reflects additional costs the benefits consultants that plan sponsors will incur to comply with the Affordable Care

 

It’s still the economy for U.S. voters in November, with health reform a distant second

There’s more confusion among U.S. voters than ever about what health reform, the Accountable Care Act (ACA), means. The September 2010 Kaiser Health Tracking Poll reveals an electorate that’s not only confused, but quite split in their support — with those who oppose the law even stronger against it than the pro’s support it. The Kaiser Family Foundation (KFF) survey found that the percentage of ACA proponents actually increased by 4 percentage points between August and September, from 45% to 49%. 41% of registered voters are “unfavorable,” and 10% still have no opinion about the law.  When it comes to

 

More Americans Covered by Government Health Programs As Employers’ Coverage Drops

In 2010, fewer Americans are receiving health coverage from employers. At the same time, more health citizens are being covered by government programs, including Medicaid, Medicare, military and veterans’ benefits. The proportion of people on government health insurance rolls increased from 22.5% in January 2008 to 25.4% in August 2010. This represents an increase of about 13%. The proportion of Americans covered by employers fell from 50% to 45.5%, a 9% decline. Thus, the number of U.S. health citizens getting absorbed into government-sponsored health programs is growing faster than the loss in the ranks of people covered by private sector health insurance. Data

 

Health and tax breaks in the U.S. – a global perspective

The U.S. has among the lowest tax-to-GDP ratios in the developed world, including state and local taxes. Only Mexico, Turkey and Korea have lower tax-to-GDP ratios among OECD members, at somewhere between 20 and 28%. The Organization for Economic Cooperation and Development (OECD) believes that U.S. tax rates are, in fact, too low and, even with modest tweaks upward, “would still keep the overall tax burden at a relatively moderate level and not impose excessive costs,” OECD states in its Economic Survey of the U.S., released today. “Tax breaks have grown significantly since the major tax reform of 1986,” the report notes, and

 

More employers will offer health insurance, RAND forecasts

What will employers do with their health insurance sponsorship once health reform kicks into full-implementation in 2014? Will they drop coverage? There’s been some speculation that more employers would exit covering employees, but researchers at RAND see quite the opposite scenario. An additional 13.6 million workers will be offered health insurance coverage in a post-ACA America, based on a forecasting model the RAND team constructed. This increases the percentage of employers offering workers health insurance from 84.6% of workers to 94.6% of workers post-reform. The increase is driven, the model predicts, by two key factors: More demand for coverage by workers due

 

A primer on primary care

More patients find doctor is not in, NPR asserted on August 30, 2010, as part of its ongoing series covering the primary care shortage in America. To understand why this statement is so important, let’s go back to the definition of “primary care.” The American Association of Family Physicians says the domain of primary care includes the primary care physician, other physicians who include some primary care services in their practices, and some non-physician providers. Central to the concept of primary care is the patient, according to AAFP. Thus, the first definition of primary care, AAFP says, is “care provided by physicians specifically

 

Can health IT transform the U.S. economy? The White House thinks so

The American Recovery and Reinvestment Act (ARRA, aka ‘stimulus funds’) is investing $100 billion worth of U.S. taxpayer dollars in projects meant to transform the American economy. $20-some billion of these funds are being earmarked for health information technology, which the White House sees as part of a “platform for private sector innovation” in a report published August 24 2010, The Recovery Act: Transforming the American Economy Through Innovation. Health IT (HIT) is bucketed with broadband and smart grid technology as planks in this economic-transformational platform. Among these three pillars, compare the $20 billion going to health IT with the $6.9 billion being

 

The role of retail health clinics post-health reform

  Retail health clinics have served American health consumers for about a decade. What have we learned over these ten years? As retail clinics proliferate the U.S. health care ecosystem, what is their impact on the health system, health consumers, and the health economy? The RAND report, Policy Implications of the Use of Retail Clinics, responds to these issues. The key implications of RAND’s study are that: – Health programs should be designed and paid-for to incorporate the adoption of retail clinics and reduce fragmentation and dis-continuity of care. – Learn from the best practices and patient outcomes gained from

 

As employers’ health costs increase 8.9% in 2011, employees will have more skin in the game

Large employers expect health care costs to increase by 8.9% in 2011, up from 7.0% in 2011. To stem cost increases, employers will adopt an array of tactics, most prominently offering consumer-directed health plans (CDHPs) and expanding wellness programs that encourage incentives to healthy lifestyles. These expectations come from Large Employers’ 2011 Health Plan Design Changes, a survey report from the National Business Group on Health poll of large employers. 1 in 5 employers say CDHPs are the most effective approach for managing health care cost growth, as shown in the chart. 61% of employers will off CDHPs in 2011, 20% of whom will

 

How to save $40 billion in health care: implement health IT in hospitals

Electronic health records (EHRs) broaden access to patient data and provide the platform for pushing evidence-based decision support to clinicians at the point-of-care. This promotes optimal care for patients, reduces medical errors, optimizes the use of labor, reduces duplication of tests, and by the way, improves patient outcomes. When done in aggregate across all health providers, a team from McKinsey estimates that $40 billion of costs could be saved in the U.S. health system. Reforming hospitals with IT investment in the McKinsey Quarterly talks about the American Reinvestment and Recovery Act’s (ARRA) $20+ billion worth of stimulus funding under the HITECH Act

 

Addressing the primary care shortage: the importance of community health centers, coupled with mobile health technology

The Affordable Care Act (ACA), aka health reform, will move 32+ million Americans to the insured population, and looks to the primary care ‘front-end’ of health care delivery to take in these newly-covered patients. Today’s USA Today reports on the primary care shortage in America. How to reconcile the influx of new patients in the U.S. health system with the deficit of primary care providers? First, the Community Health Center is one part of the solution to the primary care supply challenge. Furthermore, CHCs are integrated into ACA, seen as a key component for redesigning American health care delivery to improve quality, lower

 

That’s Dr. Geek Squad to you

Best Buy is teaming up with Cardiac Science, targeting potential purchasers of electronic health records (EHRs) and noninvasive cardiac devices. The venture looks to take advantage of economic stimulus funding available through the HITECH Act aimed at motivating physicians to adopt EHRs. Cardiac Science is a medical device company focused on the noninvasive management of heart disease. Their products include defibrillators, ECG/EKG devices, stress testing equipment, Holter and vital sign monitors. These heart-hardware products are designed to connect with electronic health records systems in hospitals and physician offices. and are used in many settings outside of health institutions including schools, emergency

 

Mayberry RFDHHS

Now showing in a 60-second spot during the 6 o’clock news: Andy Griffith’s got the starring role in promoting the peoples’ use of the Patient Protection and Affordable Care Act of 2010 (PPACA). Here is the announcement of the ad in The White House blog of July 30 2010. In the ad, Andy, now 84, recalls the signing of Medicare by President Johnson and moves into some details about the good things PPACA brings to seniors in the U.S. The Christian Science Monitor covers the story and shows the video here. This has caused quite a stir among Republicans who say

 

Women win in health reform

Women, on average, have far more contact with the health care system over their lifetimes than men do.   So kicks off an analysis of the Patient Protection and Affordable Care Act of 2010’s (PPACA) impact on women, published by The Commonwealth Fund. Realizing Health Reform’s Potential explains that PPACA should insure some 15 million women as well as give fiscal relief to those women who are under-insured or have pre-existing conditions. One of the key underlying factors which stacks the deck against women in health insurance coverage is the fact that insurance companies see young women a higher risk than

 

Health reform = meaningful use among health executives

Meeting meaningful use for inpatient EHRs is the top priority among the many challenges health executives face when considering how the Patient Protection and Affordable Care Act (PPACA) will impact their organizations. Overall, 2 in 3 health execs place MU for inpatient EHRs as the “highest priority;” among health IT executives, the proportion citing this as the highest priority is 84%. The second-most pressing PPACA priority for health executives is preparing for new models of payment, cited by 17% of health execs overall, and 31% of non-IT executives. CSC surveyed health executives in July to gauge their temperatures on several PPACA line-items including

 

It’s tough to be a governor: managing the health care lab

The National Governors Association (NGA) is meeting in Philadelphia this week, where my City of Brotherly and Sisterly Love is witnessing some sobering discussions about health care.   On the one hand, Bill Clinton called in his opening keynote speech for the states to be laboratories of democracy.   But how much health-democracy can each governor afford when balancing their budget in the face of declining revenues? According to the NGA’s 2008 Fiscal Survey of the States (published June 2008), not a whole lot.   Medicaid covers comprehensive and long-term care for over 62 million low-income Americans. Costs are shared

 

Health care inflation: thoughts on PwC’s health cost forecast for 2009

2009 will see health cost inflation of nearly 10%, according to PricewaterhouseCooper’s (PwC’s) report, Behind the Numbers: Medical Cost Trends for 2009. Medical inflation ran about 10% in 2007, as well.   PwC says that since the mid-1960s, the biggest jumps in the percentage of GDP allocated to health care in the U.S. happen during and leading up to recessions. Thus, health care becomes more of a burden for both the private sector (employers and consumers) and for the government (public sector).   Underneath this double-digit increase are both cautionary and hopeful trends:   The recession: PwC notes that if