The Self-Care Economy: OTC Medicines in the U.S. Deliver Value to the Health System

Jane Sarasohn-Kahn

Posted 2/7/12 on Health Populi

U.S. health consumers’ purchase and use of over-the-counter medicines (OTCs) generate $102 billion worth of value to the health system every year. Half of this value accrues to employers who sponsor health insurance for their workforce; 25% goes to government payers (e.g., Medicare, Medicaid); and, 25% returns to self-insured and uninsured people.

For every $1 spent on OTCs, $6.50 is saved by the U.S. health system, shown by the chart.

For millions of health consumers, OTCs substitute for a visit to a doctor’s office: most cost-savings generated by OTC use are in saved costs of not visiting a clinician, as discussed inThe Value of OTC Medicine to the United States, published by the Consumer Healthcare Products Association in January 2012.

Continue reading “The Self-Care Economy: OTC Medicines in the U.S. Deliver Value to the Health System”

Why Only Non-Health Care Business Can Save America From The Health Care Industry

Brian Klepper

The attached PP deck is a presentation I’ve given several times that has received an overwhelmingly positive, if frightened, reception.

It is, perhaps, the most disturbing public argument of my career (which is going some), because it tries to document the health care industry’s “capture” of health care regulatory processes, particularly those that govern payment. The result, as many people understand, is that the health care industry, in its rapaciousness, is effectively driving the larger US economy off a cliff.

Only one group, the non-health care business community, has the heft, influence and motivation to save us, though health care has done a good job dividing and conquering this sector as well, insinuating itself into many of the most powerful institutions (e.g., the Chambers of Commerce). It remains very unclear that the business community can be galvanized/mobilized from its malaise to turn this problem around.

The argument goes like this:

  • The data are clear that the US’ health care economy is absorbing most gains in the larger economy, and driving the US economy toward collapse. For example, nearly all increases in total compensation have been directed at increasing health costs, which in turn flows into the health industry.

The Digitization of Health Information: Why Primary Care Is At A Moneyball Moment

Jaan Sidorov

Posted 1/17/11 on Disease Management Care Blog

In a yesterday’s post, the Disease Management Care Blog used Edie Weiner’s video presentation on digitization and commoditization to launch into its own version of health care futurism.  While it struggled with notions of “opportunity costs,” it concluded that a) highly evolved patient data bases, b) biometric monitoring systems, c) artifical intelligence-based decision support and d) growing consumer acceptance of informatics will make the need for many traditional outpatient visits obsolete.

Thanks to inspiration from the movie Moneyball, the DMCB explains why.  The movie chronicles the decision of the Oakland A’s General Manager (or “GM” played by Brad Pitt) to apply a more scientific approach to recruiting players. Eschewing the largely subjective evaluation process used by his veteran scouts, the GM decides to focus on a few key player statistics.  As a result, he recruits players with high “on base” metrics and comparatively low salary demands. Success follows, and not only does he build a championship team, but he is offered a job with the legendary Red Sox. There is a telling scene filmed at Fenway Park in which the Sox owner salutes the new revolutionary approach to baseball by giving a small soliloquy on the merits of adapting or dying. Building a winning team is no longer a highly tailored and subjective approach to individual players, but data, information and insights.

Lesson learned.

Continue reading “The Digitization of Health Information: Why Primary Care Is At A Moneyball Moment”

Creating Value-Based Incentives for Primary Care

Brian Klepper and David Kibbe

Posted 6/2/11 on The Health Affairs Blog

In a remarkable recent interview, Donald Berwick MD, Administrator of the Centers for Medicare and Medicaid Services (CMS), eloquently described his vision of value-based health care.

Paying for value is an incentive…The underlying idea of improvement is that American health care, historically built in fragments, often cannot achieve for patients what it really wants to achieve…Health delivery system reform refers to really reconfiguring care into much more seamless coordinated-care operations so that people, especially those with chronic illnesses, experience continuity of care over time and space.

Continue reading “Creating Value-Based Incentives for Primary Care”

Strengthening the Primary Care Pipeline

Kenneth Lin

Posted 1/11/12 on Common Sense Family Doctor

Recently, I had a vivid dream in which I and several family physician colleagues had gathered in a lecture hall to watch the results of the National Residency Match on a huge real-time video screen. On the right side of the screen were the names of all the graduating medical students; on the left was a smaller list of those matching to residency programs in Family Medicine. A bar graph positioned in between showed the overall percentage of our graduates matching into Family Medicine programs, which in previous years had been around 5 percent.

Continue reading “Strengthening the Primary Care Pipeline”

The Social Determinants of Health: US Doctors Feel Unable to Close the Gap and Deliver Quality Care

Jane Sarasohn-Kahn

Posted 1/09/12 on Health Populi

Most U.S. primary care physicians realize the health of their patients is largely out of their hands — with their social needs ranking as important as addressing their medical conditions, according to the 2011 Physicians’ Daily Life Report, conducted on behalf of the Robert Wood Johnson Foundation by Harris Interactive in September-October 2011, results published in November 2011. In fact, unmet social needs are directly leading to worse health for Americans, say 9 in 10 doctors.

Continue reading “The Social Determinants of Health: US Doctors Feel Unable to Close the Gap and Deliver Quality Care”

Primary Care Physicians are the New Backbone for Health Care. Has the Time Come to Abandon the CPT Code?

Thomas Schwieterman 

Primary care physicians (PCP) have been identified as a critical part of the future health care value chain. Yet, we know we have far too few of them. We also know that independent providers are struggling financially.  As a result, a large number of primary care docs, perhaps a majority, have chosen to become employees of larger health systems. Most physicians label ‘salary’ as the top reason for becoming an employed clinician rather than trying to compete as an independent practitioner. But, with a CPT driven foundation for reimbursement, can this marriage between primary care and large health system be a healthy one?

When a PCP joins a health system and begins to receive a regular salary, the payments are often above that physician’s prior experiences in private practice, perhaps higher than could be reasonably calculated from the their daily productivity.  CFO’s are willing to accept the scenario of primary care salaries exceeding productivity, because they are keenly aware that the primary care physician acts as a feeder for the more lucrative profit centers at the hospital. Specialists and their ancillary staff perform most of the profit generating procedures, imaging studies, pathology examinations. These high priced resources need patients (and their insurance cards) to generate the margin-rich revenue for the financial viability of the health system.

Continue reading “Primary Care Physicians are the New Backbone for Health Care. Has the Time Come to Abandon the CPT Code?”

Graham Center: Integrate Mental Health Into Primary Care

Kenneth Lin

Posted 11/14/11 on Common Sense Family Doctor

Based in part on a positive recommendation from the U.S. Preventive Services Task Force, the Centers for Medicare and Medicaid Services recently announced that it will cover annual depression screenings for Medicare patients in primary care settings “that have staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment and follow-up.” However, as the below Figure illustrates, translating the USPSTF guideline into practice has been challenging for many primary care physicians.

Policy One-Pager from researchers at the Robert Graham Center, published in the November 1st issue of American Family Physician, details the obstacles that clinicians face in identifying and treating depression and other mental health problems. As Dr. Robert Phillips and colleagues observe, “Current health care policy makes it difficult for most primary care practices to integrate mental health staff because of insufficient reimbursement, mental health insurance carve-outs, and difficulty of supporting colocated mental health professionals, to name a few.”

On a related note, an editorial in the same issue discusses strategies for improving adult immunization rates, which have historically lagged far behind rates of immunizations in children. According to Dr. Alicia Appel, immunization registries and electronic clinical decision-support systems can complement low-tech interventions such as patient reminders and standing orders. Clinicians, what has been your experience with incorporating depression screening and immunizations into routine health care for adults?

Kenny Lin is a family physician practicing in the DC area. He writes at Common Sense Family Doctor.

Primary Care Everywhere – How the Shortage of PCPs is Driving Innovation: Especially for Patients’ Participation in Their Own Care

Jane Sarasohn-Kahn

Posted 11/04/11 on Health Populi

The signs of the primary care crisis in America are visible:

  • A growing number of visits to the emergency room for treating commonplace ailments
  • Waiting lists for signing up with and queuing lines to see primary care doctors
  • Fewer med students entering primary care disciplines
  • Maldistribution of primary care practitioners (PCPs) in underserved areas, rural, exurban and urban.

The implementation of the Affordable Care Act will (try to) enroll at least 30 million newly-insured health citizens into the U.S. health system. That’s the objective: whether being insured will actually provide people access to needed primary care is a big question given the current supply of internists, general medicine specialists, family physicians, pediatricians, and OB/GYNs.

Continue reading “Primary Care Everywhere – How the Shortage of PCPs is Driving Innovation: Especially for Patients’ Participation in Their Own Care”

Residents and Medical Students Should Support Efforts to Revalue Cognitive Services

Kevin Bernstein

First posted 9/17/11 on The Future of Family Medicine

The numbers do not lie.  As stated in a previous post and its referenced links, the payment gap between primary care and specialists has increased since the American Medical Assocation started the Resource-Based Relative Value Scale (RVS) Update Committee (“RUC”) in the early 1990s.  It is difficult to separate the two when the Center for Medicare and Medicaid Services (“CMS”) has accepted over 90% of the RUC’s recommendations throughout the years.  This can be interpreted in a number of different ways but let’s be honest – I am a current intern and do not have enough time to go through the different interpretations –  I will leave that up to your comments.

Continue reading “Residents and Medical Students Should Support Efforts to Revalue Cognitive Services”

Physician Payment Reform: An Opportunity to Bolster Primary Care

James Rickert

First posted 9/07/11 on The Health Affairs Blog

Copyright ©2011 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc. 

With the Budget Control Act of 2011 now signed into law, health care lobbyists are preparing to fight any changes to federal programs that affect their constituents.  One particular concern for physicians is the scheduled 30 percent cut to Medicare reimbursement mandated by the Sustainable Growth Rate (SGR) formula.

Any attempt to waive these cuts will need to be offset by lower spending elsewhere in the federal budget.  While no one can predict what action will occur, it appears that Congress is in no mood for increased health care spending, and some cuts are inevitable. Thoughtful and strategic changes in physician reimbursement  could meaningfully improve health care in our country while  reducing our health care spending.

Continue reading “Physician Payment Reform: An Opportunity to Bolster Primary Care”

Doctoring Financial Incentives

Paul Levy

First posted 9/12/11 on Not Running A Hospital

Mixed results are reported in a recent paper entitled, “The effect of financial incentives on the quality of health care provided by primary care physicians.”  In the paper, Australian researchers collected and analyzed data from studies of incentive programs in the US, the UK and Germany.

As noted in this summary article by Reuters:

In those studies, researchers looked to see if financial incentives made a difference in how often doctors screened for different diseases, referred patients to follow-up care or achieved a certain health outcome — such as helping a patient quit smoking. Overall, the effects were mixed.

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Primary Care in Revolt

Brian Klepper

Last Thursday Anna Wilde Mathews of the Wall Street Journal ran an article detailing the activities surrounding primary care’s gradual awakening and mobilization. With Tom McGinty, Ms. Mathews authored a damning expose on the RUC last October that precipitated our efforts on against CMS’ 20 year reliance on the AMA’s RVS Update Committee (RUC) for valuation of medical services.

Continue reading “Primary Care in Revolt”

The Practice of Medicine: From Marcus Welby to ???

Jaan Sidorov and Vince Kuraitis

First posted 8/17/11 on e-CareManagement Blog

Physicians face great uncertainty. According to a survey conducted byThe Physicians Foundation, the great majority of physicians (89%) believe the traditional model of independent private practice is either “on shaky ground” or “is a dinosaur soon to go extinct.”

In the face of this uncertainty, many physicians are jumping to a conclusion that “I have to sell my practice to the hospital.” In this post of our series on The 100 Year Shift, we will examine physician practice.  We’ll show that the economic and clinical environment  is changing rapidly and that selling to the hospital is one option. However, it is not the only option.

Continue reading “The Practice of Medicine: From Marcus Welby to ???”

Community Health Centers: Local Economic Engines and Cost-Effective Primary Care Providers

Jane Sarasohn-Kahn

First posted 8/09/11 on Health Populi

As the recession drags on and millions of people in the U.S. lack health insurance, there’s a community resource that extends primary care to them that’s not in a doctor’s office: it’s in Community Health Centers (CHCs). There are over 8,000 CHCs throughout the U.S., and 20 million people use them as medical homes — providing 25% of all primary care visits for low-income people in America.

At the same time, there are 60 million people in the U.S. who do not have access to primary care due to the maldistribution and shortage of primary care providers (PCPs). Access Endangered: Profiles of the Medically Disenfranchised, a report published by the National Association of Community Health Centers, details the growing challenge of filling the gap between the limited supply of PCPs and growing demand for their services.

The most convenient place for medically disenfranchised people to gain access to primary care is in the most expensive, if accessible, health provider setting: the closest emergency room.

The fact is that funding for Community Health Centers is scaling back, due to Congress’s recent reduction in the Health Centers Program midway through FY2011. This action, combined with the fiscal fact that other funding sources at the state and federal levels are threatened due to the economy and debt discussion, endangers CHC patients’ access to health care.

Continue reading “Community Health Centers: Local Economic Engines and Cost-Effective Primary Care Providers”