Checking Up On Health: July 30, 2013

Health Policy News and Views
Compiled by Benita M. Dodd

Benita Dodd Vice President, Georgia Public Policy Foundation
Benita Dodd
Vice President, Georgia Public Policy Foundation

Save the date: The Heartland Institute’s Emerging Issues Forum is coming to Atlanta on Thursday, August 15. This is Heartland’s annual daylong event for elected officials, policy analysts and government affairs professionals to confer and strategize about the top public policy issues of the day. Among the topics: Health Care, Education, Energy and Tax Reform. (I’ll be part of the panel on energy issues.)  The keynote speaker is Congressman Tom Price of Georgia. Find out more at http://eif.heartland.org/.

But wait! There’s more! The Georgia Public Policy Foundation, which will be a sponsor at the event, is giving away four tickets, valued at $100 each, to the daylong session. For a chance to win a ticket, tell your Facebook friends what you like about the Foundation and why. Be sure to “like” the Foundation Facebook page and tag us in your post or we won’t know! We’ll announce four winners in the Friday Facts next week, so make your case by noon on Thursday, August 8. Remember, if you don’t tag us, we can’t see you!

Disclosure time: Beginning Aug. 1, the nation’s medical device makers and drug companies will begin what is expected to become a massive stockpile of data on their financial relationships with doctors, researchers and teaching hospitals. A new federal disclosure law they report payments to physicians, hospitals and other health care businesses that are more than $100 a year. Payments can include travel expenses, entertainment, consulting fees and research support. The new rules stemmed from concerns health companies were gaining inappropriate influence over research, education and clinical decisions. The Physician Payment Sunshine Act was folded into the Affordable Care Act in 2010. Source: Star-Tribune

Overdiagnosis, overreaction: Many Americans are being over-diagnosed and over-treated for cancer and better definitions of cancer and new molecular diagnostic technologies could help solve the problem, according to a working group of the National Cancer Institute. In a new viewpoint article in the Journal of the American Medical Association, the working group says that many people have lesions or other abnormalities that are officially called cancer, but which may not prove harmful during their lifetimes. This broad definition of cancer is leading to overtreatment — too many biopsies, operations, and radiation and chemotherapy treatments bring their own risks and psychological pain, the group argues.

The more, the moneyer: A new Medscape survey of physicians found that about 40 percent of survey respondents have been named in a lawsuit, 31 percent of them as one of many parties named and 9 percent as the only physician named in the suit.  Lawyers say that’s because, “If you sue only one doctor, you’re limited by that doctor’s coverage. By naming several parties and the hospital, you try to maximize the coverage available.” The specialties reporting the most lawsuits were internal medicine (15 percent), family medicine (13 percent), ob/gyn (9 percent), psychiatry (8 percent), gastroenterology (6 percent), cardiology (6 percent), and pediatrics (5 percent). That makes sense, of course, because there are more primary care physicians than specialists. The vast majority of doctors had no inkling that they would be sued; 59 percent there was no trigger event. Twenty-four percent of the cases were dismissed prior to depositions, but nearly a half of the cases went to depositions (45 percent), while 21 percent went all the way to trial. That gibes with what has been reported, and it’s why the Georgia Public Policy Foundation likes the fairness of a Patients’ Compensation System. Source: Medscape.com

Gambling man: My friend Michael Cannon of the Cato Institute is making a serious prediction: “Based on the White House’s past lawlessness and corruption in the service

Cato Institute President John Allison (left) with Benita Dodd and Michael Cannon of Cato
Cato Institute President John Allison (left) with Benita Dodd and Michael Cannon of Cato

of ObamaCare, I’m willing to venture the following prediction: The Obama administration will announce in August, probably in a classic Friday news dump, that (1) it will offer Exchange subsidies to workers enrolled in multiemployer union plans, and (2) it will pay the FEHBP contribution toward the Exchange premiums for members of Congress and their staffs. Here’s what makes this prediction interesting: neither of those things would be legal. So, for the record, I really hope this prediction does not come true.”

And Cannon points out: “The last time I made a prediction was this one from December 2012: ‘HHS maintains they’ll have these [Exchange] things up and running by October 2013. I don’t know anyone who is confident about that and I’m ready to predict that they will not.’ That prediction proved true when the Obama administration announced the eligibility verification system for Exchange subsidies would not be ready on time, and took the not-legal step of delaying enforcement of the eligibility rules for a year.”

A billion here, a billion there: In its May 2013 baseline projections, the Congressional Budget Office projected that the insurance coverage provisions of the Affordable Care Act would have a net cost to the federal government of $1,363 billion over the 10-year period from 2014 to 2023. “As a result of the Administration’s announcement and recently issued final rules [no penalties on employers and reporting requirements], the net cost is now estimated to be $1,375 billion – $12 billion more than previously estimated. The largest change is a $10 billion reduction in penalty payments by employers that would have been collected in 2015. (Penalties assessed for 2014 would have been collected in 2015.) Costs for exchange subsidies are expected to increase by $3 billion. Other small changes, including an increase in taxable compensation resulting from fewer people enrolling in employment-based coverage, will offset those increases by about $1 billion.” Source: Congressional Budget Office

Thinking about working a little overtime? It could cost you thousands. An individual or family whose annual income surpasses maximums set by the federal government – if only by $1 – will totally lose subsidies available to buy health insurance under the Affordable Care Act. The loss of those subsidies in some cases will mean that people potentially would have been better off financially if they had worked less during the year, says Jonathan Wu of ValuePenguin.com. And they would have to work significantly more to make up for the lost subsidy. No need to panic; the feds don’t plan to verify your income anytime soon anyway.  Source: CNBC.com

There’s an app for that: Currently, the most-downloaded health care app in the United States is a medical image-sharing app. Figure 1, launched by Canadian company Movable Science, allows users (90 percent of whom are physicians) to share and comment on medical images. The app has a face-detection algorithm to prevent images with patients’ faces to be shared, and other privacy-protecting information is included in the app’s instructions, according to the report. The app is currently only available on the iOS platform, but an Android version is in the works, according to the report. Source: Canadian Medical Association Journal

Top five health care apps: More than half of physicians who own smartphones use apps in clinical work settings, according to a survey conducted by American EHR Partners. Becker’s Hospital Review asked five physicians to share their most useful apps. Emergency physician Kim Greene-Liebowitz named Epocrates, “incredibly helpful in determining dosing, prescriptions” and similar data. Pediatrician Michael D. Klein, MD named pingmd, which makes him available by text message to his patients’ families and supports photo and video to help better explain the ailment. Cardiologist Wilbur Su said Micromedex, a medication database that is “comprehensive and very easy to navigate for pertinent information about use of a drug.” Gynecological surgeon Kurian Thott likes instaRounds, “which we use in my practice every day, for patient sign out. It has improved patient safety features and improved physician communication features.” Anesthesiologist Charles Tullius likes Anesthesiologist: “Just plug in the patient’s weight and age, and it provides doses of many common drugs, including emergency drugs.”

Not just a phone anymore: Patients’ failure to follow physician recommendations accounts for $290 billion in health care costs annually, suggesting traditional discharge literature may have limited effect, according to a report by Mobiquity. Mobile technology, on the other hand, can be particularly successful in changing patient behavior because of several attributes. Smartphones and similar devices are readily available as decisions are being made; they provide awareness of the user’s location, social setting and recent activity, giving context to decision-making; their cameras, accelerometers and microphones allow for data collection, and they provide real-time feedback. $290 billion for not following orders?! Source: Becker’s Hospital Review (Read my recent commentary on the growing role of telemedicine.)

Quotes of note:

“Men who are occupied in the restoration of health to other men, by the joint exertion of skill and humanity, are above all the great of the earth. They even partake of divinity, since to preserve and renew is almost as noble as to create.” – Voltaire

“My health is good; it’s my age that’s bad.” – Roy Acuff

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