The Sunshine Act

Shining a light on the physician-Big Pharma relationship

One of the little-known laws buried in the Affordable Care Act (ACA) is the Physician Payments Sunshine Act, which takes effect today.

I understand the impetus of this law, but I am less sure of its positive effect.

The Sunshine Act (the drafters no doubt had a mental image of exposing something slimy to the light) seeks to illuminate the financial relationships between doctors/teaching hospitals and drug companies/medical device manufacturers.

Conflicts of interest and questionable ethics have been problems for years as public funding has decreased and private industry money has … Continue reading

Weekly rounds July 26, 2013

I’m not saying it’s cronyism…

The Los Angeles Times reported that the health insurance giant WellPoint, which operates health plans in several states, including California, posted a strong 2nd-quarter profit jump of 24%.

Carl McDonald, a health care analyst, was quoted:

“Earnings from WellPoint’s government business more than doubled sequentially in the second quarter, aided by the California Medicaid business, favorable Medicare prescription drug plan, seasonality, and what was likely another strong quarter of Medicare Advantage results.”

Interestingly, as I pointed out in a post last January, a former WellPoint vice-president, Elizabeth Fowler, worked closely with Senator Max … Continue reading

Obamacare and dental health

Dental health is important, isn’t it?

Starting in 2014, the Affordable Care Act (ACA) mandates that all insurance plans cover “essential health benefits,” including vision and dental benefits for children.

Obviously pediatric eye and dental health are important to the crafters of the ACA; but what about adults? We have eyes and teeth, too!

Even though many preventive services, such as annual exams, mammograms, and even breast pumps are covered, routine eye and dental exams are not.

I posted a few months ago that I thought it a shame that preventive vision care had received so little support in health Continue reading

About those hospital rankings…

hospital rankingsUS News & World Report publishes hospital rankings for 2013

And the winner is…Johns Hopkins Hospital in Baltimore! Great, but what does that mean?

Every July US News & World Report publishes a list of what it considers to be the best hospitals in America.

The rankings are mostly based on an analysis of death rates for certain complicated procedures, patient safety statistics acquired from Medicare data, and a physician survey (which hospital do you think is best?)

Because the analysis requires enough patient data to make a judgement, the list is dominated by large, urban, university-affiliated medical centers. Like … Continue reading

Weekly rounds July 12, 2013

How much does good health cost? Apparently less than we are spending…

Once again, a study has shown that although Americans far outspend other countries on health care, our health is poor in comparison.

The healthiest citizens, no surprise, are in the wealthier cities and states, and vice versa. And it’s not because they can afford better health insurance. Other studies have linked education and income level to better lifestyle choices – diet and exercise – rather than access to health care.

In my opinion, we should be spending tax-payer dollars on all levels of education (Congress, what about … Continue reading

Weekly rounds July 5, 2013

Big companies get a temporary break from Obamacare

Other than Egypt’s turmoil, the biggest news this week was out of the Treasury Department, which announced that they were going to delay a key feature of Obamacare until January 2015.

Delayed one year is the mandate that large businesses (those that employ over 50 people) must provide health insurance for their employees or pay a fine.

Small businesses (under 50 people) are not affected because they are not mandated to provide health insurance. Of course, if they want to, they can, but will have limited options because of the previously announced Continue reading

Weekly rounds June 28, 2013

June 24-28, 2013It seems to have been a busy week in health care news, and I found it difficult to settle on what interested me the most. But here are my picks:

Coke for breakfast?

Apparently that is one of the marketing strategies Coca-Cola is considering to increase its sales in the United Kingdom. It is not clear whether they mean to actually pitch the idea that a Coke would be a great accompaniment to a bowl of oatmeal (maybe an Egg McMuffin) or they mean to develop a new line of beverages to compete with tea and coffee. But sales of … Continue reading

Weekly rounds May 31, 2013

Ready, Set, . . .

With the implementation of the Affordable Care Act (ACA) fast approaching, and summer deadlines for insurance companies that want to offer plans on the new insurance exchanges, this week has seen a lot of news stories related to Obamacare.

California revealed its new exchange plans and the first look seems to indicate that premiums will be much lower than anticipated, even though several of the largest insurance companies opted out of participating in the exchanges.

But a closer look at the plans reveals two important considerations:

  1. The plans are “narrow-network” plans. To keep costs
Continue reading

Weekly rounds May 17, 2013

Stock up on DEET?

Any report that contains the word “deadly” gets the attention of the media, and this report by the Centers for Disease Control (CDC) was no exception. Last year 5,674 cases of the mosquito-borne virus were reported, and 286 people died. In comparison, only 43 deaths were recorded in 2011.

Weather conditions that favored the mosquito – warm and humid – were probably factors in last year’s increase in cases.

This news reminds me that I want to spend some time researching insect repellents and then write a post about them. Does anything work as well as … Continue reading

The cost of cancer

Cancer and bankruptcy

A large study looking at the cost of cancer was released yesterday by the Hutchinson Institute for Cancer Outcomes Research in Seattle. It offers a somber but perhaps not surprising conclusion that cancer patients are “2.5 times as likely as others [non cancer patients] to file for bankruptcy.”

The highest rates are seen among young women, largely because young people are often uninsured, have little savings, and have part-time or entry-level jobs. But as the study points out, even those with insurance can face “financial distress” because of the high cost of deductibles, co-pays and other non-covered … Continue reading

The high costs of medical mistakes

I mentioned in a previous post that three years ago my husband almost died from a series of medical, um, misjudgments, let’s say. I know sometimes things go wrong for no reason, but I also know his three-day ICU stay could have been prevented.

He never received a “mea culpa” from the doctors or hospital; all we got were the medical bills. Our insurance, a catastrophic/health savings account (HSA) plan, paid 100% of the costs after we met our deductible and out-of-pocket maximum ($10,000). At that point we stopped receiving bills, so I don’t know the exact total of … Continue reading

Tragedy’s heavy toll

Like many others, I’m still trying to understand Monday’s horrific bombings at the Boston Marathon. Who did this, and why?

What I do know is that our emergency response and medical teams are the best in the world; I used to work in the OR of a large, level-one trauma center and have seen these teams in action. The injured will receive swift and highly-skilled care without regard to pre-existing conditions or insurance status.

However, a different team, the patient accounts personnel, will work quickly to document victims’ names, addresses and insurance carriers (if any).

It seems a second tragedy … Continue reading

Should smoking be considered a pre-existing condition?

That is the opinion of the health exchange boards in Washington, D.C., California, Connecticut, Massachusetts, Rhode Island and Vermont (so far).

Each state (and D.C.) that creates a health insurance exchange under the Affordable Care Act (ACA) has an exchange board that is responsible for establishing certain rules and guidelines. Some definitions in the federal reform law have proved to be ill-defined and open to interpretation, such as “pre-existing condition.”

Most insurers that sell individual health plans charge smokers higher premiums because smokers … Continue reading

Obamacare: A double whammy for some

A few days ago, more bad news came out about the cost of individual health insurance in 2014. The Society of Actuaries (the financial risk experts that determine insurance costs) reported that next year insurance companies must anticipate paying out at least 32% more in medical claims.

The Affordable Care Act (ACA) will require insurance plans to provide more comprehensive coverage (essential benefits) and cover millions more people with pre-existing conditions. There is considerable doubt about how many young, healthy people and how many small businesses will participate in the insurance exchanges. If they don’t, premiums will rise even … Continue reading

Man the lifeboats

Under the Affordable Care Act (ACA), small businesses and individuals will be offered “robust” coverage and “affordable” premiums on the soon-to-be-running health insurance exchanges.

By grouping together these two traditionally under-served populations, the risk pool will become large enough (theoretically) to allow everyone (most notably those with pre-existing conditions) access to health insurance, and will help keep premiums affordable (again, theoretically).

But there is a problem: small businesses are jumping ship.

According to the National Review Online, “Small firms and the specialized insurers that serve them may have found the lifeboats (to borrow Texas governor Rick Perry’s comparison of … Continue reading