27. March 2008 by Jon Moss.

Washington Post
March 18, 2008

Between now and next month, Lou Bruhn, 65, of Fairfax County will have to make an important decision about his medical care: Should he pay $1,500 a year to stick with his primary care physician of three years — a doctor who he says has given him excellent care? Or should he resign himself to finding another doctor?

Some 5,000 Northern Virginia residents are mulling the same question after learning that their Franconia family practitioners, Brett Wohler and Andrew Wise, are switching to what’s sometimes called boutique, or concierge, care. On April 15, the pair will join a national doctors’ network and will charge each patient an annual retainer of $1,500. In return, the physicians say they will offer more attention, including round-the-clock cellphone access, same-day appointments and time to accompany their patients to specialists.

The move follows a nationwide trend that began nearly 12 years ago as a reaction to what some doctors see as the excesses of managed care. More than 1,000 doctors have switched to this mode of practice, according to the Society for Innovative Medical Practice Design, a trade group in Richmond.

Under concierge plans, doctors typically reduce the size of their practice so they can stretch patient visits to 30 minutes, compared with the seven to 16 minutes that various studies have found to be average under managed care. In addition to their annual retainers, doctors collect the usual fees for service or reimbursements from patients’ health insurance plans. The doctors also accept Medicare patients.

Proponents say concierge care lets doctors give patients the time and services they deserve, and allows them to focus more on preventive care. But critics say the development exacerbates inequities in the American health-care system by limiting access and increasing the workload of doctors who don’t join such networks.

Several years ago, only a handful of Washington area doctors listed themselves as members of MDVIP, the nation’s largest retainer health-care company and the one Wohler and Wise are joining. By June 1, the area will have nearly two dozen MDVIP doctors, according to company officials, with 15 in Northern Virginia, six in Maryland and one in the District.

“It’s not really about the money; I can afford it,” said Bruhn, a retired engineer and a patient of Wise’s. “I guess I’m still curious to see if it works as well as the doctors seem to believe, and if that would be worth the price for me.”

But some other patients are less sanguine.

To convert to the new plan, Wohler and Wise plan to drop about 4,000 of their 5,000 patients. Remaining patients, up to 1,000, will be selected on a first-come, first-served basis, they say, leaving the rest to find a new physician they can trust.

Lisa Zuber, 51, of Springfield, is one of them. A patient of Wohler’s since 2004, she said that she initially considered following him into his new plan. But the more she learned about concierge care, the more it made her uncomfortable.

“I guess what bugs me so much is that even if everyone wanted to join, they couldn’t,” said Zuber, an administrator for a national professional association. “It sets up this situation where people are competing against each other to get health care. I just didn’t want to be a part of that.”

Wohler voiced regret about the situation. “There are patients that I’ve seen for years that probably will not continue, and that’s hard,” he said in an interview last week. “Part of me asked myself, ‘Is this right?’ But I firmly believe I’ll be getting back to doing the things that I set out to do when I first became a doctor.”

MDVIP requires doctors like Wohler to help each of his patients find a new primary care physician, and they don’t stop seeing them until they do.

Last week about 50 patients attended an information session in Springfield hosted by Wohler and Wise, complete with a video touting the benefits of the program. Here, too, patient views were mixed. “I’m absolutely going to join,” said Arthur Smith of Fairfax County. “There doesn’t seem to be any drawback.”

Others were more cautious.

“It makes you wonder where we’re going as a health-care system,” said a patient of Wise’s, who identified himself only as Ray and declined to give his last name. “I understand where these doctors are coming from — all the paperwork they have to fill out, no time with patients. . . . It can make you feel like you’re really not doing your job.”

Doctors and medical ethicists across the country continue to debate the trend toward concierge medicine.

In a policy statement several years ago, the American Medical Association said that while retainer contracts offer viable options for care, “they also raise ethical concerns that warrant careful attention, particularly if retainer practices become so widespread as to threaten access to care.”

Even short of that, some have expressed concern about limiting access to care for poorer, sicker and nonwhite patients.

A 2005 survey of 144 retainer doctors in the Journal of General Internal Medicine found that such practices had far fewer minority and Medicaid patients than non-retainer doctors.

“This really isn’t a solution to the chief problem in our health-care system, which is maldistribution,” said Jay Jacobson, chief of the division of medical ethics and humanities at the University of Utah School of Medicine, who wasn’t involved in the survey. “By giving more people an opportunity to opt out, they’re not addressing the problem of access to health care.”

Others have questioned how much impact retainer practices are having. The 1,000 or so retainer physicians, they say, are few compared with the more than 280,000 primary care physicians nationwide.

“Reasonable people can disagree about the practice, and they certainly have been a lightning rod for controversy,” said G. Caleb Alexander, an assistant professor of medicine at the University of Chicago, who co-authored the Journal of General Internal Medicine study. “But it’s unclear to me how viable the market is right now.”

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10. March 2008 by Jon Moss.

The State of Georgia has passed a bill to encourage insurance companies to offer cheap, affordable, and limited health insurance plans. The bill passed by Georgia’s Senate will give insurance companies an opportunity offer health insurance to Georgians who are unable to afford a comprehensive plan. The republican proposal passed 42-12 in the House. Now, individuals searching for affordable Georgia health insurance can pick a plan based on what they can afford. Although the coverage will be limited, the limited coverage is still better than no coverage at all. 

Democrats who apposed the plan are worried that individuals who obtain the limited plans will not truly understand the coverage of the plan and will only make their decision to purchase based solely on price. Democrats predict that the future of this plan is flawed because its popularity may grow tremendously in the future but coverage will not be sufficient for most.

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27. February 2008 by Jon Moss.

Last Sunday the Wichita Eagle published a story on how a local Kansas hospital has discounted  slashed their price on a common type of heart surgery.  They did it to be more competitive in the marketplace.  Apparently they felt strongly about gaining more share of the market.  They’re even advertising in Canada and the UK (for people who don’t want to wait for their government-provided medical plans to schedule procedures, and are willing to pay)  Here’s the story in it’s entirety:

Galichia Heart Hospital says it will begin charging a flat fee of $10,000 for one of the most common types of open heart surgery — undercutting hospital charges by at least $25,000.

The discounted fee is the latest plan by the physician-owned hospital to attract more patients. The hospital also promises a 15-minute wait time and a $50 co-pay in its emergency room.

Galichia officials say the discounted rate applies to standard coronary artery bypass graft surgery, but only for cases where there is little chance for complications. Patients with risky health issues such as diabetes or who have had the surgery before are not eligible.

Hospital officials are frank about their motives: They want a bigger piece of the patient base in Wichita and beyond.

“We’re very serious about presenting cost-effective products and options for our community and for the region and nationally,” Galichia hospital chief executive Steve Harris said.

“I think it will turn some heads. This isn’t just a good rate. It’s a world-class rate.”

Getting patients

About five of every 1,000 people need open-heart surgery every year, so a community this size produces roughly 2,000 procedures annually, Harris said.

Surgeons at Galichia Heart Hospital perform about 200 open-heart surgeries a year. Harris said he would like to see that increase by 100 this year.

The idea behind the rate cut is threefold, he said. The hospital wants to attract cash-paying uninsured workers, get the attention of insurance providers and cost-conscious employers in Wichita, and tap into medical tourism — the trend of patients going out of the country to purchase affordable surgery.

“We’re making money at this rate,” Harris said. “We’re challenging our colleagues to really square off against rising health care costs.”

Physician-owned hospitals in Wichita have historically struggled for market share in a city where the two major hospital systems — Via Christi Regional Medical Center and Wesley Medical Center — contract exclusively with insurance providers.

Galichia officials are hoping their new rate causes the area’s largest insurers — Blue Cross and Blue Shield of Kansas and Via Christi-owned Preferred Health Systems — to consider steering some of their client base to Galichia.

“This is a much better rate than anybody else is giving Blue Cross or Preferred Health,” Harris said. “We’re not an in-network provider. We’re sort of challenging (them) to rethink their contracting strategies.”

Blue Cross, at least, is intrigued, although the state’s largest insurer said it would abide by its contractual obligations.

“Blue Cross… members are free to receive services from any hospital they choose with the understanding that their benefits will be applied differently when they use non-contracting facilities,” spokeswoman Mary Beth Chambers said.

“We direct members to the hospitals where we have contracts because of the discounts we receive from those contracting providers. If one hospital is charging less than others in the area then that is good for the community and could help lower overall health care costs for everyone.”

Making waves

Galichia’s new rate could threaten larger community hospitals, although executives at each declined to comment.

Administrators at Kansas Heart Hospital, of which Via Christi is a minority owner, said the Galichia plan is “very interesting” but unlikely to make a dent in their business, which is based largely on physician referrals.

“I’m not sure what impact it could have,” said Lynn Jeane, chief operating officer. “And I’m not sure how many people needing heart surgery are going to be out shopping for the lowest price.”

Supporters say physician-owned hospitals are extremely efficient, making such cost-cutting strategies possible.

“It’s a gutsy move, but I understand what they’re trying to get done,” said Jim Sergeant, past president of the Kansas Surgical Hospital Association and chief executive of Salina Surgical Hospital. “If you take a hard look at costs, you can do premier services at a very good price.”

Galichia hospital also is running ads this weekend in Canada and the United Kingdom, targeting countries where government health plans have created long waits for elective surgeries. Such environments have fostered medical tourism to such places as India, where patients can get procedures done inexpensively.

“The price… is absolutely stunning,” said Rick Baker, a Canadian who founded Timely Medical Alternatives and North American Surgery. His companies connect clients with specialty hospitals that agree to perform certain surgeries at low, contracted rates.

“The solution to America’s health care problems is (for) people to find a way to negotiate very good prices,” he said.

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26. February 2008 by Jon Moss.

A slew of bills proposed in the current session of the Kentucky General Assembly would require health insurers to expand services they must cover.  The proposed mandates have sparked opposition from Kentucky doctors and health insurance providers.  The proposed legislation includes bills that would require health benefit plans to cover services such as colorectal cancer screenings and mammograms. Other proposals address terms of the relationships between health care providers and health insurance companies.

Melodie Shrader, executive director of the Kentucky Association of Health Plans, said many of the proposals are “unnecessary regulation.” The association represents six insurance providers, including Humana, Anthem. and Aetna.

If the past is any indication, whenever government mandates benefits rates usually go up.

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26. February 2008 by Jon Moss.

If you don’t have UnitedHealthcare as your group medical provider, then you probably aren’t aware of EmployerEservices.  If you do have United, and don’t know, then you may want to question your existing broker.

EmployerEservices allows your company to manage virtually every aspect of benefit administration online and in real-time.  The benefits are increased efficiency as well as saving time & money.  Here are some of the tasks that can be accomplished on EmployerEservice:  We’ve found that most clients want us to do the service on their behalf using the system, but some really like the hands-on control.  If you’d like to know more check out http://www.welcometoemployereservices.com/online/, or contact us for more information.

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23. February 2008 by Jon Moss.

NY Times article illustrates some of the differences between Clinton’s & Obama’s healthcare reform ideas:

 Brandy Coons is what health economists call a free rider.

She may not fully appreciate it, but her decision to go without health insurance , like millions of similarly situated Americans, has become central to the pre-eminent policy dispute of the Democratic presidential campaign.

Ms. Coons, a 23-year-old waitress who rents a room and rarely eats out, said she could probably afford a high-deductible policy if she gave up her gym membership and spent less on her amateur photography. But she chooses instead to gamble against the odds of confronting a bankrupting catastrophe.

“I’m young and in pretty good shape,” Ms. Coons said one recent afternoon, on her way to the treadmill at the Fitness Factory in Midtown Atlanta. “I looked at Blue Cross Blue Shield. But the only thing I could see myself really needing it for are prescriptions and dental because there are so many free clinics, or a hospital visit really isn’t all that expensive.”

She continued, “The insurance premium was more than what I would pay for my prescriptions, so I just decided not to deal with it.”

Senator Hillary Rodham Clinton contends that the only way to achieve universal health coverage, and to make the marketplace fair and efficient, is to require that everyone have insurance. That would include people like Ms. Coons, who may not currently rank health care above other needs and wants.

Senator Barack Obama , Mrs. Clinton’s rival for the Democratic presidential nomination, shares her goal of insuring all Americans. But he says that a mandate could mean financial devastation for middle-class families if the government did not first adequately reduce the cost of insurance.

Both candidates express confidence that by pumping at least $110 billion into subsidies and tax credits they can make policies affordable for all. The difference is that Mr. Obama insists he will be able to lure all of the uninsured simply by dangling the carrot of low premiums; Mrs. Clinton believes there will always be some free riders who respond only to a government stick.

Neither campaign has provided enough detail about its plan to enable more than guesswork about how it might influence consumers like Ms. Coons. They have not detailed what kind of subsidies would be needed or who would be entitled to them. Mrs. Clinton has not fully explained how she would make everyone comply with her plan or exactly how she would cap the amount a family would have to spend on premiums.

Each candidate would raise the money needed to subsidize premiums by rolling back President Bush’s tax cuts for high earners, taxing businesses that do not insure their workers and reducing costs through electronic record keeping, preventive medicine and chronic disease management.

But there is little certainty about how much those initiatives might save, or when. Nor can it be known if the savings would offset the potential cost of new technology and drugs and the cost of providing care to the newly insured. There are also questions about whether the new savings and tax increases would be enough to subsidize insurance for all who need help.

Both candidates are backed by teams of prominent economists from top universities and policy groups. But with little real-world precedent to guide them, their assessments are necessarily an amalgam of statistical modeling and back-of-the-envelope calculation.

“In a campaign, people put out proposals that aren’t highly specified, that don’t have enough detail to model them effectively,” said E. Richard Brown, director of the Center for Health Policy Research at the University of California, Los Angeles, and an Obama adviser. “These numbers are based on a lot of assumptions.”

In speeches, debates and dueling advertisements, Mrs. Clinton and Mr. Obama have brandished projections that even their originators acknowledge are tenuous.

Mrs. Clinton, for instance, has charged repeatedly that Mr. Obama’s plan would leave 15 million people uninsured. Doing so, she has said, amounts to Democratic apostasy. “I don’t want to leave anybody out,” she said in Thursday’s debate in Austin, Tex.

But the economist who devised that number, Jonathan Gruber of the Massachusetts Institute of Technology , said that while he felt strongly that a mandate was needed to achieve universal coverage, he was less firm about his projection. “There is a lot of margin for error around that estimate,” Mr. Gruber said.

Mr. Obama, meanwhile, maintains in a television advertisement that his plan will “cover everyone.” That claim is disputed by some of his own advisers, including Mr. Brown, who recently calculated that the Obama plan might leave behind two million free riders.

“That’s the number we would expect to continue to be uninsured unless they’re forced to buy coverage,” Mr. Brown said.

Article continues….

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22. February 2008 by Jon Moss.

At the University of Arkansas, student health insurance has been taken into the University’s hands. Every student is automatically enrolled into the school’s minimal health insurance plan. With a charge of $6.77 per credit hour, students receive care by physicians, registered nurses, and other healthcare professionals at the University’s health center. The fundamental health insurance plan covers basic things like office visits but other services require an out of pocket expense. Some vaccines and immunizations can be a substantial cost from a student’s perspective. Since prescriptions are not covered under the student health insurance plan, some students seek assistance from a parent’s employer plan or their own student Arkansas Health Insurance plan from an outside provider.            Students will receive coverage for most services performed at the Student Health Center but in the case that a student needs an MRI; the maximum coverage of $2,000 can be met quickly. About 70% to 80% of students at the University of Arkansas receive additional assistance from another health insurance provider. At other universities, about 1/3 of the students in Arkansas have no form of health insurance. This is becoming a growing trend among young adults. The high costs of health insurance has drove many students to opt out of a health insurance plan as the cost has become unattainable at this time in their young lives.

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19. February 2008 by Jon Moss.

Humana has a nifty little tool allowing for the access and analysis of small employer group plan utilization.  Would it be helpful for you as a small business to be able to know how often your employees:

• visit the doctor
• purchase prescription drugs
• meet deductibles & out-of-pocket maximums

 That type of information is extremely important to employee benefit specialists.  It allow us to determine which benefits are more important to the employees, and which ones are less used.  When implementing an HSA or HRA knowing this type of data is crucial to the success of the plan.

 Humana has recently updated BUD to allow brokers, and the small businesses they advise, access to actionable, group-specific benefit information previously available only to large companies, allowing employers to model the impact of different benefit designs, track health plan usage, and ultimately better budget for employee health care – a large and growing bottom-line expense for many small firms.

“BUD empowers brokers to deliver an unparalleled level of guidance to small companies as they make critical decisions about their health coverage,” said Jerry Ganoni, president, Humana Small Business. “Many companies unknowingly provide richer benefits than their employees use or want. With knowledge gleaned from BUD, small businesses are better able to choose the most appropriate health benefits solution for their workforce.”

Designed with the help of Humana’s actively-appointed brokers and agents, BUD features two primary tools to help employers choose and use their health plan with confidence: the Health Utilization Tool and the Contribution Strategy Tool, both of which protect the privacy of employee health information by removing identifying data.

The Health Utilization Tool offers employers information about employee usage of key services, including doctor office visits, prescription drug purchases, inpatient admissions, outpatient surgery and emergency room visits. Brokers can show small employers how the usage of these services by their own employees compares with that of similar accounts in the same geographic area and industry. Brokers can help employers track deductibles and out-of-pocket expenses to see how many employees have satisfied zero percent, 50 percent or more, and 100 percent of their in- and out-of-network limits.

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19. February 2008 by Jon Moss.

AvMed Health Plans announced recently it is adding several new small group plans, some of which are 50 percent less than their existing plans.

The lower-priced plans offer low co-payments for routine visits to primary care physicians and specialists and low co-pays for prescription drugs. The company is also adding new pairing choices to allow small group employers more flexibility.

Gainesville-based AvMed Health Plans provides health care coverage to both small and large employer groups in Florida and has offices in Orlando, Miami, Fort Lauderdale, Tampa, Gainesville and Jacksonville. The company also provides Medicare in Miami-Dade and Broward counties.

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19. February 2008 by Jon Moss.

A bill introduced in the Georgia General Assembly aims to put the skids on double-digit increases in health insurance premiums in the state.

But opponents fear new regulations could spook some insurance carriers from entering the Georgia market.

If House Bill 923 becomes law, health insurance companies will not be allowed to issue new health insurance products or impose renewal increases on health products until rates have been approved by state regulators. Carriers would have to financially justify rate hike requests. Thirteen states have similar requirements for health insurance carriers.

Critics of the bill say it would artificially lower rates, keep new insurers out of Georgia and drive smaller, less capitalized players out of business. Proponents say the legislation, which has an identical version in the Senate, would hold health insurers accountable for the rates they charge, something that insurers in other markets — such as auto and homeowners — are already subject to. Escalating health insurance premiums have contributed to the uninsured rolls, currently at about 1.7 million in Georgia.

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