Health Department Bars Insurance Aids

The Miami Herald reported on September 11th 2013 that Florida government officials created another hurdle to the new health insurance marketplace, which opens in Florida on Oct. 1. Citing "privacy concerns" health department officials explicitly prohibit outreach workers known as navigators to assist and support eligible Floridians to sign up for health insurance. The order from Deputy Health Secretary C. Meade Grigg went out late Monday to the 60 local health department directors across the state emphasizing that the outreach workers intend to collect consumer information that will be gathered for use in a federal database which is, according to the underlying "thought process" of the health department officials, inherently unsafe. Health and Human Services Department spokesman Fabien Levy called the Florida directive “another blatant and shameful attempt to intimidate groups who will be working to inform Americans about their new health insurance options and help them enroll in coverage, just like Medicare counselors have been doing for years.” In a Miami Herald editorial titled " Rubbing salt into the wound" the authors characterized the state officials action as "outrageous and spiteful" and emphasized that this " will not prevent those who need help with healthcare insurance from getting it, but it will make it harder for them to do so. It represents a unilateral and shameful denial of service by the state to its own citizens." Furthermore, the editorial pointed out that "it strains credulity to believe that privacy is a practical concern. In the first place, virtually all Americans — anyone who contributes to Social Security, pays taxes to the IRS, is a veteran of the armed forces or otherwise has any contact with the federal government — is already in a federal database of one sort or another without privacy becoming a serious concern." Florida state officials also seem to ignore that U.S. Health and Human Services officials have stated unequivocally that “consumers will never be asked to provide their personal health information to the (insurance) Marketplace, whether through a Navigator or not.” This shameful action taken by the Florida government is intended to sacrifice the health and well being ( maybe even lives) of almost 4 million uninsured Floridians on the altar of ideological purity. If health department officials still have a conscience then they should resign in protest. Otherwise, they are nothing but spineless bureaucrats working for a government which ignores the needs and rights of its own citizen. Shame on you!! Yours Bernd

Does Fear Drive Defensive Medicine?

A recent study published in the journal Health Affairs revealed that whether a physician practices defensive medicine may depend more on a doctor’s fear of being sued than the level of noneconomic damages caps and insurance premiums in that physician’s state. The research was conducted by the Center for Studying Health System Change, a policy research organization, examined responses from 3,469 physicians to questions about how concerned they were about medical liability lawsuits in the center’s 2008 Health Tracking Physician Survey. Then they compared the physicians’ concerns with actual Medicare claims for more than 1.9 million patients who came to their offices with headaches, chest pain or lower back pain from 2007 to 2009. Physicians who reported a high level of malpractice concern were most likely to engage in practices that would be considered defensive when diagnosing patients who visited their offices with new complaints of chest pain, headache, or lower back pain. Of the conditions studied, chest pain was the most common (n = 12,161), followed by lower back pain (n = 10,109) and headache (n = 6809). For patients with headache, the likelihood that a medium-concern physician would order advanced imaging was 8.5% compared with 6.4% for a low-concern physician (P ≤ .05). Similarly, the likelihood a high-concern physician would order advanced imaging was 11.5% (P ≤ .05 compared with physicians at both the low- and medium-concern levels). Similarly, if the patient had low back pain, the likelihood was 22.4% that a physician with a medium degree of concern would order conventional imaging compared with 17.6% for low-concern physicians (P ≤ .05) and 29.0% for high-concern physicians (P ≤ .05 when compared with physicians with low or medium levels of concern). High-concern physicians were also significantly more likely than low-concern physicians to order advanced imaging (6.1% vs 4.1%; P ≤ .05; no significant difference was seen for physicians with a medium degree of concern). However, there was a 1.6% likelihood that medium-concern physicians would order a trip to the ED compared with 1.0% for low-concern physicians (P ≤ 05) and 1.4% for high-concern physicians (difference not significant). The authors suggested that reducing defensive medicine may require approaches focused on physicians’ perceptions of legal risk and the underlying factors driving those perceptions. In my opinion we also should provide physicians the tools to provide defensible medicine by utilizing patient encounter documentation templates, evidence based treatment approaches and patient-centered outcome guidelines. All of these components are part of the Affordable Care Act and should be translated into practice sooner than later. Yours Bernd

Medicare Myth

"The reports of my death are greatly exaggerated." Mark Twain Critics of the Medicare program often allege that the restrictive Medicare regulations and bare-bone reimbursements are causing a rising number of doctors to refuse to serve Medicare patients.According to a recent editorial in the NYT "In the critics’ most dire scenarios, baby boomers nearing retirement age could find that their current doctors are no longer willing to treat them under Medicare and that other doctors are turning them down as well." But is this true? A recent analysis by experts at the Department of Health and Human Services finally debunked this myth! The analysts looked at seven years of federal survey data and found that doctors are not fleeing Medicare in droves; in fact, the percentage of doctors accepting new Medicare patients actually rose to 90.7 percent in 2012 from 87.9 percent in 2005. They are not shunning Medicare patients for better-paying private patients, either; the percentage of doctors accepting new Medicare patients in recent years was slightly higher than the percentage accepting new privately insured patients. Still, a small number of doctors have dropped out of the Medicare program. Roughly 9,500 practicing doctors have currently opted out of Medicare, according to the Centers for Medicare and Medicaid Services but the number of doctors opting out is tiny compared with the number of doctors, 735,000, who remain in Medicare. These findings should encourage us to work even closer with Medicare, to participate in quality improvements and pay-for-performance initiatives to reduce healthcare costs and to maintain this valuable program which provides essential healthcare for 16% of US citizens. Yours Bernd