Sue the Patient

Dan Munro

Posted 4/27/12 on Forbes

States often confer the tax-exempt status on hospitals with the expectation that certainly some services will be extended to the less fortunate with limited capacity to pay. Two of the more litigious hospitals in North Carolina are Carolinas HealthCare and Wilkes Regional Medical Center in North Wilkesboro. They each filed over 12,000 lawsuits against patients in the same five-year period. One of the controlling entities – Carolinas HealthCare System – reported annual profits of more than $300 million over the last three years. One facility, Carolinas Medical Center-Mercy (CMC-Mercy) promotes itself as a “Planetree Designated Patient-Centered Hospital.” Planetree, Inc (itself a non-profit) offers tiered designations (Bronze, Silver and Gold) for “achievement in patient-/person-centered care based on evidence and standards.” The designation appears to be loosely based on an “application review fee” ($2,500 – $5,000) and includes a “self-assessment.” CMC-Mercy’s Gold Designation status is prominently featured on the hospital’s website:

CMC-Mercy – Planetree Gold Designation

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PhRMa’s Free Ride in Health Care Reform

Dan Munro

Posted 3/05/12 on Forbes

You may recall that last year the DOJ agreed to a settlement with Google for $500 million. Basically Larry Page needed to avoid criminal prosecution for actively helping Canadian Pharmacies advertise to American consumers more effectively with Google AdWords.  That alone probably wouldn’t have raised any eyebrows except that the profits were being siphoned away from American pharmaceutical companies (at scale) and of course that simply can’t be allowed to happen.  Pure speculation on my part to say that pharma lobbying helped, but in either case, the DOJ filed criminal charges which forced the settlement. Open and shut case – now closed.  But here’s the thing – it’s a story that keeps repeating itself – in not so nuanced ways.  This time the thread starts with a fairly safe and upbeat report from our Nations largest e-prescribing network – Surescripts. Aptly titled: E-Prescribing Shown to Improve Outcomes and Save Healthcare System Billions of Dollars. Fabulous news. Let’s dive in.

So it turns out that the first bit of news isn’t that good.  According to the World Health Organization “as many as 50% of patients do not adhere fully to their medication treatment, leading to 125,000 premature deaths and $290B annually in the form of increased hospitalizations and costly complications (U.S. only).” Ok – so that’s not good at all.  It’s easy to dismiss the data (it’s from 2003) but still – 50%? According to Kaiser Permanente there were about 3.7B prescriptions filled in the U.S. in 2010 for a total in retail sales of about $221B.  So, in effect, the healthcare costs of poor drug adherence exceeds the total retail sales of all drugs in this country ($290B vs. $221B). While those two numbers aren’t related – it’s safe to say that the cost of poor drug adherence trumps any incremental value we’re able to get through e-prescribing by a very wide margin. In effect, non-adherence accounts for almost 10% of our $3 trillion National Healthcare Expenditure (NHE).

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Health Care’s Medical Gluttony

Dan Munro

Posted 1/31/12 on Forbes

Dan MunroSeems to me we always have a few big breaking healthcare stories early in the year.  I remember last year when Mary Meeker released her stunning report – USA, Inc.  For the first time, it gave us a detailed view into the health of our country – as if it were a Corporation using balance sheet accounting.  That report is truly outstanding.  If you haven’t read it – I can’t recommend it highly enough.  In some ways I think it’s “table stakes” for any intelligent discussion around the health (and healthcare) of our Country. In that report are two charts that graphically illustrate the size of our healthcare spending (as reported through 2009) – and then the results of our healthcare system.  This was the first one:

US Health Care Hits $3 Trillion

Dan Munro

Posted 1/19/12 on Forbes

Dan MunroGreat post by Rick Ungar over on The Policy Page. Still, I’m left wondering. It’s an election year and given the stakes, I think we’ll look back on 2012 as the year of the great Healthcare Reform debate – Part 2. What we have today is really just the beginning of a long and winding investment in Healthcare Reform – Part 1. I think the question remains – have we tamed the cost beast with real legislation – or is it just legislation around the edges? Here’s why I’m wondering.

National Healthcare Expenditure – or NHE. Total agreement with Rick that costs are “out-of-control” because our NHE is really $3 trillion – this year. Actually, NHE for 2012 is probably closer to $2.7 trillion but there’s this nagging bookkeeping accrual of about $300 billion where we (narrowly) avoided those darn pesky SGR cuts to Medicare. It’s come to be known affectionately as “doc fix” – and we’ve kicked that can down the road for 9 consecutive years. Maybe we’ll just write it off – and maybe we should – but it’s actually on the books so we can’t just ignore it – can we? That puts the real NHE at about $3 trillion for 2012 (+ about 4% for each year forward – as far as the eye can see). As one economist said – we don’t have a debt problem in this country – we have a healthcare problem.

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