According to protocol: How will already-busy emergency departments handle the extra business coming their way under ObamaCare, physician Peter Ubel wondered in a recent Forbes column. He noted: “Currently, many hospitals make lots of money providing expensive emergency room care to patients with private insurance or even Medicare. We need to change incentives, so it is not in hospitals’ best interest to prolong observational care.”
Ubel cites a solution that Health Affairs reported in a recent study: protocol-driven observation units.
An observation unit, typically adjacent to the ER, is where patients stay briefly so that their symptoms can be evaluated. “Clinically speaking, these patients are ‘tweeners’ – neither sick enough to need full on emergency services nor healthy enough to go home, nor so seriously ill that they need to be hospitalized.” In a protocol-driven observation unit, clinicians follow guidelines for how to care for specific health conditions.
The Georgia-based study found that patients in Emory/Grady Memorial Hospital’s protocol-driven unit were discharged within 24 hours, either to home or the hospital, whereas other hospitals in Georgia and in the United States overall included “a sizeable minority of patients who lingered in these units for days on end.” The researchers estimate that if all hospitals utilized protocol-driven observational units, the U.S. health care system would save $5.5 billion to $8.5 billion annually.
Ubel’s column didn’t tackle what should be done about the physician shortages predicted.
Unions won’t pay: “Disputes between unions and employers over paying for new costs associated with the Affordable Care Act are roiling labor talks nationwide,” according to The Wall Street Journal. “Unions and employers are tussling over who will pick up the tab for new mandates, such as coverage for dependent children to age 26, as well as future costs, such as a tax on premium health plans starting in 2018. The question is poised to become a significant point of tension as tens of thousands of labor contracts covering millions of workers expire in the next several years, with ACA-related cost increases ranging from 5% to 12.5% in current talks.”
Employers can’t pay: Employers who had the notion to give employees a tax-free contribution of cash to help pay premiums for a plan through a health insurance exchange can’t do so, according to the Obama administration. The New York Times reports that a ruling this month by the Internal Revenue Service “blocks any wholesale move by employers to dump employees into the exchanges.” Employers may be subject to a tax penalty of $100 a day – or $36,500 a year – for each employee who goes into the individual marketplace.
No sale: Pfizer has ended its controversial bid to buy British rival AstraZeneca after its $117 billion offer was rejected last week. The purchase, which would have been the biggest deal of its kind in the pharmaceutical industry, raised fears that Britain would lose jobs and research capability. Pfizer was also accused of a “cynical ploy” to pay less in U.S. taxes by relocating to Britain, according to IndustryWeek.
Which brings to mind two questions. (Answers are at the end of this post.)
A) Which nation has the highest corporate tax rates in the world?
B) Who said this? “Anyone may arrange his affairs so that his taxes shall be as low as possible; he is not bound to choose that pattern which best pays the treasury. There is not even a patriotic duty to increase one’s taxes. Over and over again the Courts have said that there is nothing sinister in so arranging affairs as to keep taxes as low as possible. Everyone does it, rich and poor alike and all do right, for nobody owes any public duty to pay more than the law demands.”
Good ideas, questionable execution: Laws requiring special labeling on biotech foods in Massachusetts and other U.S. states should be based on science, instead of fear, writes Claire Parker, spokeswoman for the Coalition for Safe Affordable Food. The Food and Drug Administration and major scientific bodies agree that biotech foods are not different from conventional foods, and a recent analysis of almost 2,000 studies found no single credible scientific study that showed biotech foods pose risks, she writes. The biotech food labeling proposal in Massachusetts “is not about consumer choice. It is about a coordinated and concerted effort to eradicate biotechnology from American agriculture,” Parker writes in the Boston Globe. She’s right about that. Plus, the life-saving abilities of genetically modified organisms are almost miraculous. On the other hand, handing more regulatory powers to the foot-dragging FDA seems to be a little self-defeating.
‘Sorry’ won’t cut it. Wisconsin’s Senate has passed legislation making physician apologies, condolences and expressions of sympathy toward patients regarding the health care provider’s actions inadmissible in civil proceedings and administrative hearings. Opponents, including trial attorneys, argue the change would make it harder for patients to bring successful malpractice lawsuits, according to an Anchorage Daily News report.
No papers? No problem: California’s state Senate passed legislation that would allow illegal immigrants to practice medicine, according to a Los Angeles Times report. State licensing boards would be permitted to accept applicants’ taxpayer identification numbers as a valid form of identification rather than their Social Security numbers, which is the current requirement, according to the report. Supporters of the bill say the legislation would provide the nearly 2 million undocumented immigrants in California with an opportunity for upward mobility, according to the report. Interesting that in one state you’d be able to practice medicine if you’re not legally in this country while in most states you can’t practice medicine inside that state from anywhere else unless you have a license in the state you want to practice.
Drug trial volunteers needed: New drugs and the testing regulations have grown more complex even as the number of suitable drug trial volunteers has declined, The Washington Post reports. Manufacturers are looking beyond the traditional volunteer pool. “We have to rebuild some trust and have to rebuild our network,” said Terri Hinkley, the Association of Clinical Research Professionals’ deputy executive director. Hint: Start paying “volunteers.”
Quote of Note:
“Convinced of their own virtue and the vice of others, many physicians crave more regulations. They hope that in the next round will emerge the regulatory Thor wielding his nuanced hammer on evil Medicare serpents and fraudsters. Instead we receive the leviathanic, uncoordinated Moby Dick that throws Queequeg out with Ahab and splashes a lot of salt water in the process.” – Saurabh Jha
“This is the art of medicine. This ability to recognize patterns, to integrate a lof of variables and clinical data points and come out with an accurate, back-of-the-envelope estimate of risk, that is the hallmark of a true physician. It comes with time. We all start off as algorithm-driven neophytes and some never seem to progress beyond that point. But for the Mr. Smith I see every day, who doesn’t want to be admitted to the hospital again (he never does), but he also doesn’t want to die, he really values having a ‘good doctor.'” – “Shadowfax,” blogger at KevinMD.com
A: The United States has the highest corporate tax rate.
B) Judge Learned Hand, considered one of the most influential American judges never to have served on the U.S. Supreme Court.