Author Archives: joycefr

Down to Business: The Policy & Practice Podcast

Courtesy Flickr Creative Commons user House of Sims

Health policy this week is all about the money: will physicians get their pending Medicare fee cut repealed? Will health insurers be barred from raising their rates too much in the wake of Anthem’s rate hike request? Last but not least, will President Obama make any headway at the summit he is hosting later this week in an effort to get Congress to pass a big-ticket health reform bill?

It’s all in this week’s Policy & Practice podcast. Lend us your ear and give us your comments.

–Joyce Frieden (Twitter @joycefr)

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Filed under Physician Reimbursement, Podcast, Practice Trends

The Budget Unveiled: The Policy & Practice Podcast


Courtesy Flickr Creative Commons user Photo Phiend

While all of Washington hoped in vain that the coming snowstorms wouldn’t cause too much disruption, Congress kept itself busy indoors by examining the President’s budget proposal. Health and Human Services Secretary Kathleen Sebelius touted the proposal’s lack of Medicare physician pay cuts, and Medicare actuaries predicted that health spending would once again outpace the nation’s economic growth.

It’s all in this week’s Policy & Practice podcast. Give a listen and send us your comments.

–Joyce Frieden (Twitter @joycefr)
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Filed under Health Policy, health reform, IMNG, Podcast

The Hidden Conditions of Health Reform

Courtesy Flickr Creative Commons user andercismo

Much of the discussion on health reform has centered around the obvious and the controversial: whether there should be a public option, if Medicare should be expanded, and what the policy on abortion coverage should be. But there are a few less visible provisions that can make a big difference in the lives of American consumers.

The first one is health insurance exchanges. This is the part of the reform plan — included in both the House and Senate bills — that would allow individuals and small businesses to pool their buying power and purchase their health coverage through an exchange set up by either the states or the federal government.

And therein lies the rub: should the exchange be federal (as required in the House bill) or state-by-state (as in the Senate bill)? That sounds like a trivial issue, but some experts are worried that if it’s left to the states to set up the exchanges, there could be a lot more problems. “State governments vary in their ability to see if rules are enforced,” John Garamendi, a former California insurance commissioner who is currently a Democratic Congressman from that state, said during a conference call sponsored by Health Care for America Now. “You can wind up with a commissioner who has no interest in protecting consumers, but is interested in protecting insurers.”

Another concern with the exchanges is that insurers are not required to use them. Instead, both the House and Senate bills allow some insurers to sell policies outside the exchange, where regulations will be much weaker. “The Senate bill, I believe, leaves the door open for  insurers who decide to stay completely out of the exchange to set up plans that are configured to attract the best risks away from the exchange, and leave the exchange with more expensive, high-risk groups,” Timothy Jost, the Robert L. Willett Family professor of law at Washington and Lee University, said at a briefing sponsored by the Alliance for Health Reform.

Some Wall Street analysts who follow health insurers expect them to make much use of the outside-the-exchange option. “I’d argue that [health] plans will have a large focus on plans sold outside the exchange,” Carl McDonald of Oppenheimer & Co. said during a conference call sponsored by Atlantic Information Services. He noted that in Massachusetts, which already has a health exchange, “the vast number of people that have bought insurance through the exchange have been the people receiving subsidies; if they weren’t receiving subsidies, the majority continued to buy in the market outside the exchange.”

Then there are the rules governing wellness programs — the programs designed to give employees monetary incentives for trying to lose weight or lower their blood pressure. The Senate bill allows for employers to give discounts of up to 30% on health insurance premiums based not just on whether employees participate in the programs, but on how well they do at meeting weight or other health goals set by the employer. 

For example, an employer could set this year’s health insurance premium $1,000 higher than last year’s, and then tell employees that they’ll knock $500 if they meet the weight goal and another $500 if they meet the cholesterol goal. But employees who do not meet the goals will have to pay the higher premium, unless they can prove there is a medical reason why the goals are unattainable for them.

Finally, there is the overall cost issue. Health care attorney Miles Zaremski noted in an interview that although they may not be allowed to discriminate against people with pre-existing health conditions, “the insurance companies are having no checks on what they can charge,” meaning that they are likely to raise premiums for everyone. “It’s symptomatic of the lack of a gatekeeper on insurance companies.” And because there is no public option to help hold premiums down, “this ‘Cadillac tax’ on higher-cost health plans that President Obama favors will hit the average worker when the bill goes into effect,” Mr. Zaremski said.

These aspects of health reform aren’t getting much notice now. But after health reform passes, we may be hearing a lot more about them.

–Joyce Frieden (Twitter @joycefr)
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Last-Minute Reform: The Policy & Practice Podcast

Photo of Union Station in Washington courtesy Flickr Creative Commons user PhillipC

After much debate and an attempted derailment, the Senate finally manages to pass its version of a health reform bill — early on Christmas Eve — before dashing home for the holidays. Next stop: the House-Senate conference committee, where major differences over abortion and a public option still wait to be ironed out. Physician groups express cautious optimism that at least something is being done.

All this awaits you in the Policy & Practice podcast. Give a listen and tell us your thoughts; we’ll be back with another podcast on Jan. 11th.

—Joyce Frieden (Twitter @joycefr)
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Cheaper Drugs, More Medicare: The Policy & Practice Podcast

Photo courtesy Flickr Creative Commons user mcclouds

The health reform battle slogged on last week, with new proposals emerging to break the stalemate: allowing reimportation of drugs from other countries, and ditching the public option in favor of expanding Medicare to include people aged 55-64. Meanwhile, physicians were left wondering whether Congress was going to act to stave off an impending 21% cut in Medicare reimbursement for doctors.

It’s all in the Policy & Practice podcast. Give a listen and let us know what you think.

–Joyce Frieden (Twitter @joycefr)
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Filed under Health Policy, health reform, IMNG, Physician Reimbursement, Podcast, Practice Trends

Not All Turkey and Football: The Policy & Practice Podcast

Thanksgiving football photo courtesy Flickr Creative Commons user Kahala

The Senate cleared a big hurdle last week when it voted 60-39 to bring its health reform bill to the floor for debate. Now the horse race begins as senators jockey with Majority Leader Harry Reid for the provisions they would like to see changed or added. In the meantime, physicians are waiting to see whether the Medicare fee fix approved by the House last week will be taken up by the Senate after the Thanksgiving break.

It’s all in the Policy & Practice Podcast. Give a listen and let us know what you think.

–Joyce Frieden (Twitter @joycefr)
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Coalitions Splinter: The Policy & Practice Podcast


Photo courtesy Flickr Creative Commons user Mccready

The House approves a health care reform bill, but Democrats splinter over an abortion provision. The bill receives support from the American Medical Association, but some surgeons’ groups beg to differ. And physicians of all specialties await a Congressional fix to the Medicare SGR formula.

It’s all in this week’s Policy & Practice podcast. Take a listen and let us know what you think.

–Joyce Frieden (Twitter @joycefr)
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Filed under Health Policy, health reform, Neurology and Neurological Surgery, Obstetrics and Gynecology, Podcast, Practice Trends, Surgery

Not Your Usual After-Lunch Speech

From the annual meeting of the American Academy of Psychiatry and the Law in Baltimore, MD:


Photo of Patrick Kennedy courtesy U.S. House of Representatives

It’s not every day when you hear a luncheon speaker discuss how his mom used to greet visitors at the front door while she was less than fully clothed. Especially when the speaker is a member of Congress.

But Rep. Patrick Kennedy (D-R.I.) spoke with no holds barred when he discussed his family’s addiction battles. “My mom had the worst case of alcoholism that you could possibly imagine,” he said to the assembled group of psychiatrists. “And we kept it a big secret — or so we thought. Until one of my friends would come over, and their mom would come over to pick them up, and my mom would answer the door completely naked. And they’d be like, ‘What’s going on in this house?'”

Rep. Kennedy continued, “And you can’t begin to imagine the amount of denial. My mom would be driving us to school … and be sideswiping cars all the way to elementary school. It was the most well-known, least-hidden secret from the world, and yet nobody said a word about ‘Maybe this is not safe.’ … For many famlies, that still happens, and it’s still going on in most of America, and that’s really scary.” He noted that even though addiction is “a physical illness, a genetic illness, yet we do nothing to treat it as such because we’re so mired in an old-fashioned view of this thing as a reflection of someone’s moral turpitude that they’re insufficient in their ability to control their behavior.”

He also discussed his own ongoing addiction battle. “‘When I went back to treatment this last year after having 2 1/2 years of sobriety, I was in treatment with three members of the Special Forces — two Navy SEALs and one Green Beret. Now I’m telling you, if this is about control of your behavior, these are probably the most powerful, self-disciplined, powerful individuals our society could produce … So it just brings home the fact that this isn’t about self-control, because if it were, how could people that could pass every other test in the world in terms of self-discipline lose the one that comes about as a result of controlling themselves with respect to a disease called addiction?”

Members of the audience seemed to like what they heard; they gave him a standing ovation when he finished.

–Joyce Frieden (Twitter @joycefr)
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Making Waves On and Off the Hill: The Policy & Practice Podcast

From hearings and press conferences in Washington, DC:

Photo of Olympia Snowe courtesy United States Senate

Photo of Olympia Snowe courtesy United States Senate

The Democratic-controlled Senate Finance Committee finally passed a health reform bill with a little help from the other side of the aisle: a Yes vote from Maine Republican Olympia Snowe. Meanwhile, health insurers and medical device makers sound alarm bells about their concerns, and Sen. Tom Harkin (D-Iowa) voices his opinions on antitrust for health insurers and a public option for health reform.

It’s all in the Policy & Practice podcast. Have a listen and let us know what you think.

— Joyce Frieden (Twitter @joycefr)
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Whose Medical Record Is It Anyway?

From a federal advisory committee meeting in Washington, D.C.:

Photo courtesy Flickr Creative Commons user Fabian.Nikon

Courtesy Flickr Creative Commons user Fabian.Nikon

You’d think that a meeting of the federal Health Information Technology Standards Committee would be pretty dull, but actually, the discussions can get interesting. Such was the case on Oct. 14, when the panel discussed how much online access patients should have to their health records.

No one had a problem with patients having access to their diagnoses, lab results, and medication lists; those were no-brainers. A few panelists, such as Jamie Ferguson of Kaiser Permanente, also praised their organizations’ ability to allow patients to refill prescriptions online or have email exchanges with their physicians.

The interesting part of the discussion came when committee chair Jonathan Perlin, of the Hospital Corporation of America, asked whether panelists thought patients should have access to physician notes.

Panel vice-chair Dr. John Halamka of Harvard Medical School said that his organization’s definition of an online personal health record includes a problem list, medication list, allergies, lab results and other test results, but not the physician’s notes. He pointed out that HIPAA regulations permit patients to physically go to the facility’s medical records department and get their complete medical record. However, when his hospital launched its personal health record system,  “we tried to tell our physicians…. ‘We’re going to share every observation you made about the patient with the patient themselves,’ and there was some resistance,” he said. “If I said [in my notes], ‘I have just met with a slightly depressed obese man’ and the patient is now going to see that — that’s controversial.”

Linda Fischetti of the Department of Veterans Affairs (VA) said her agency releases health information electronically “in a way that repects the clinician’s role” in caring for the patient. For example, if a patient has a lab result that is abnormal, the VA will alert the physician — thus creating a delay — before releasing the record.

Judy Murphy of Aurora Health Care in Milwaukee, Wisc., said, “In terms of personal health records, we’ve been real selective in what we’ve been doing — we only [release] lab results and even then it’s at the specific discretion of the physician to release them.” But she added that releasing more information to patients “is where we need to be going if we’re really going to be patient-centric…. This is all about the patient, and we absolutely have to make sure we’re partnering with the patient and not seeing this as our data, but seeing it as data we’re working on together as a team.”

Physicians, how comfortable are you with sharing the electronic medical record? Where would you prefer to draw the line? Take our poll and let us know.

–Joyce Frieden (Twitter @joycefr)
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