August 28, 2015 – New Premiums – More for Less
Dr. Joseph R. Maldonado
August 28, 2015
Volume 15, Number 33
This week, the Wall Street Journal reported a story about rising healthcare premiums. While President Obama expected that premium rate increase requests would come in “significantly lower” than what was then being requested, reality has proven his expectations wrong. The story reports a premium rate increase of over 36% for a Blue Cross Blue Shield product in Tennessee. The White House rationalizes that this is still better than what was previously available. Patients now have the option of enrolling with other products. In New York, we are beginning to realize, this usually means purchasing insurance products that offer less. They come at a lower premium but often carry higher deductibles and have narrower networks with stringent accessing protocols.
The story reinforces the lessons I learned from my advisors and professors Bent Flyvbjerg and Paolo Quattrone when I was at Oxford. Bent’s expertise lies in understanding why megaprojects fail to deliver on time, on budget and on-agenda. He proposes that their failure is due to “optimism bias” and “strategic misrepresentation.” Quattrone proposes that when numbers are proposed to us in accounting reports, one should look at what is NOT being presented to understand where the real agenda lies. Accounting reports tell you what the writer wishes to tell you and not what is necessarily financially driving the organization. These lessons are critical to understand if we are to fully comprehend where we are going on the healthcare transformation train.
Language Couches Reality
Many, in the sincere hope of changing the flaws of our healthcare system, have succumbed to the rhetoric of the “optimism bias”— its effective language; its painted a rosy picture and emotionally evocative narratives painting an illusion of better quality and access to care. From the trenches, we hear otherwise. We hear the stories of patients feeling a highly impersonal healthcare engagement that is driven by process and outcomes. The person within the patient is no longer a priority of the art of medicine, there is no art – there’s merely science and technology.
When the optimism bias is not being engaged, the more nefarious strategic misrepresentation is being utilized. Quattrone presents this as very legitimate accounting processes that artfully hide the truth of the impending dangers. We see these every day— reports that project losses and justify premium hikes while healthcare corporate officers rake in reprehensible salaries.
How do we respond to this optimism bias, strategic misrepresentation and to the “maieutic” machine?
MSSNY is currently advocating for collective negotiations capabilities for physicians and exploring other mechanisms within safe harbor regulations that allow for greater collaboration in the efforts to bring about meaningful healthcare reform.
In the interim, each of us must individually weigh whether or not we will continue to play in the sandbox.
Joseph Maldonado, M.D, MSc, MBA, DipEBHC
Please send your comments to email@example.com
NYS Kindergarten Students Must Have Complete Set of Vaccinations
Effective Sept. 1, New York state pupils “entering kindergarten can no longer wait until age seven before parents demonstrate a completed series of vaccinations against highly contagious childhood infections, state health officials” announced on Aug. 27. The new rule will “require full doses of specific vaccines” before youngsters are allowed to go to kindergarten. In a statement yesterday, New York State Health Commissioner Howard Zucker, MD, JD, said, “These revisions are based on the most current science and will give our children the best protection we can provide from devastating diseases.”
NY Medical Students Honored with AMA Foundation MSSNY/Dr. Duane and Joyce Cady Physicans of Tomorrow Awards
This week, the AMA Foundation presented MSSNY/Dr. Duane and Joyce Cady Physicians of Tomorrow Awards to rising fourth-year medical students Victor Hoang, Natasha Ramsey and Michelle Smith. Each recipient was nominated by their medical school and will receive a $10,000 scholarship recognizing academic achievement.
Victor Hoang, a student at Touro College of Osteopathic Medicine, has spent summers working with Project Vietnam, building clinics and providing medical care for underserved villages in Vietnam. He has been awarded a Welch Scholars Grant in recognition of leadership, research, and academic achievement. While a student at Touro, Hoang has served as the president of the Obstetrics and Gynecology Student Organization. He earned a bachelor’s degree in molecular environmental biology from the University of California Berkeley.
Natasha Ramsey, a student at New York University School of Medicine, is pursuing a dual MD/MPH degree. She founded the Students Teaching About Real Subjects (STARS) Program, an all-girls health group dedicated to creating a safe environment to discuss topics surrounding sexual health. Ramsey also volunteers with the FOCUS program, mentoring NYU undergraduates who are first-generation college and/or minority students. Ramsey earned a bachelor’s degree in public health from Rutgers University.
Michelle Smith, a student at the University of Buffalo School of Medicine and Biomedical Sciences, was awarded the John and Janet Sung Scholarship for incoming first-year University at Buffalo medical students who demonstrate academic merit, need, and compassion for medicine. She served as fundraising chair and community service chair for the Medical Society of the State of New York (MSSNY). She led MSSNY’s partnership with St. Jude Children’s Hospital to create a statewide event benefitting New York state pediatric oncology patients. Smith graduated summa cum laude from Siena College in Loudonville, NY with a bachelor’s degree in biology.
The Physicians of Tomorrow Awards were created in 2004 to provide financial assistance to medical students facing spiraling medical school debt. On average, medical students in the U.S. graduate with a debt load of nearly $162,000. A large debt burden may deter many from practicing in underserved areas of the country or practicing primary care medicine. To date, over 1 million has been granted to exceptional medical students across the nation.
Cuomo Announces Awards to Academic Medical Institutes
On August 27, Governor Cuomo announced $17.2 million in state awards to 26 academic medical institutions for the training of new clinical researchers working on cutting-edge biomedical research. These awards, administered over a two year period through the Empire Clinical Research Investigator Program, are vital to helping New York both attract new researchers and solidify itself as a national biomedical research hub.
Over the next two years, more than 86 physician researchers will be trained as a result of this funding in diverse research fields, including: heart and kidney disease, traumatic brain injury, human cancer genomics, health information technology, population health, and stem cell therapy. Once program researchers conclude their training through this program, they will be well prepared for careers in research.
The program supports two types of awards — team-based Center Awards and Individual Awards. Center Awards provide funding for teaching hospitals to form research teams focused on a specific topic, disease, or condition. This will not only further the development of clinician researchers, but also give these hospitals a foundation from which they can seek additional funding from the federal government to build upon their work.
Twelve institutions will receive Center Awards, with each receiving $1,260,332 over two years for the training of a team comprised of at least six fellows. For five of the 12 Center Award recipients, the awards will support both a primary and secondary project, and all 12 institutions have each committed at least $200,000 in direct matching funds for their projects.
Individual Awards are being made to 14 teaching hospitals, each of which will receive up to $150,000 over two years, to train program researchers in diverse research fields such as obesity, diabetes, lupus, kidney transplant, schizophrenia, HPV infection, and hearing loss.
The winners are as follows:
- HealthAlliance Hospital (Mid-Hudson)
- Lincoln Medical and Mental Health Center (NYC)
- Memorial Sloan-Kettering Cancer Center (NYC)
- Montefiore Medical Center (NYC)
- Mount Sinai Hospital (NYC)
- New York Presbyterian – Columbia University (NYC)
- New York Presbyterian – Weill Cornell Medical College (NYC)
- North Shore University Hospital (Long Island)
- NYU Langone Medical Center (NYC)
- SUNY Downstate (NYC)
- Westchester Medical Center (Mid-Hudson)
- University of Rochester Medical Center (Finger Lakes)
- Elmhurst Hospital Center (NYC)
- Erie County Medical Center (Western NY)
- Hospital for Special Surgery (NYC)
- Kings County Hospital Center (NYC)
- Lenox Hill Hospital – North Shore LIJ Health System (NYC)
- Long Island Jewish Medical Center – North Shore LIJ Health System (NYC)
- Maimonides Medical Center (NYC)
- Montefiore/New Rochelle (Mid-Hudson)
- Mount Sinai Beth Israel (NYC)
- New York Eye and Ear Infirmary of Mount Sinai (NYC)
- New York Hospital Queens (NYC)
- New York Methodist Hospital (NYC)
- Staten Island University Hospital – North Shore LIJ Health System (NYC)
- Winthrop University Hospital (Long Island)For more information on the Empire Clinical Research Investigator Program visit:http://www.health.ny.gov/professionals/doctors/graduate_medical_education/ecrip.
Members Only: Your Patients Can Save Up to 75% on Prescriptions
With the rising cost of both generic and name brand medications, your patients could all use some help these days! The New York RX Card, MSSNY’s newest Member Benefit, is a 100% Free and 100% confidential point of sale prescription discount card that can save your patients up to 75% onprescription medications! It is free to everyone with no minimum nor maximum uses, no age or income requirements, no enrollment or approval process and it is accepted at over 68,000 pharmacies, nationwide!
This card will provide you with Rx medication savings of up to 75% at more than 68,000 pharmacies across the country including CVS/pharmacy, Duane Reade, A&P, Hannaford, Kinney, Kmart, Pathmark, Stop and Shop, Target, Tops, Waldbaums, Walgreens, Walmart, Wegmans, and many more. You can create as many cards as you need. We encourage you to give cards to friends and family members. This card is pre-activated and can be used immediately!
The NYRX Card works on lowest price logic, to guarantee the best prices on medications. It won’t lower co-pays or replace existing insurance, but in some cases the New York Rx price is even lower than your patients’ co-pay! It can be used during the deductible periods in Health Savings Accounts and High Deductible Plans, lowering out-of pocket-expense on prescriptions. Medicare Part D recipients can use the card to discount their prescriptions not covered on their plan as well as receive discounts on medications not discounted when in the “donut hole.”
The NYRX Card is pre-activated and ready to go with no personal information taken or given. NYRX will mail as many cards you desire, directly to your office, with display stands. The cards typically are placed at the patient check out area…additionally, some doctors place them at the check in area too. Contact firstname.lastname@example.org for your cards!
Feds Rule that HHS Can Use Geography as Basis for Payments
Federal law gives HHS “flexibility and discretion” in calculating the reimbursement rate for providers in different geographic areas based on local wages, a federal appeals court judge has ruled on August 15.
A federal appeals court’s rejection this month of a lawsuit challenging the way the U.S. Department of Health and Human Services calculated the Medicare reimbursement rates in 2006 and 2007 sends a clear message to healthcare leaders: Don’t expect Medicare to change its ways to keep things fair.
The lawsuit was filed by 41 New England hospitals seeking $24 million in damages from what they argued were unreasonably low reimbursement rates. More specifically, the hospitals contested the HHS secretary’s decision in 2005 to change the boundaries of the geographic areas used to compute regional wage indices.
The wage indices are critical to hospital reimbursement rates because the cost of providing care can vary significantly depending on where a hospital is located, the hospitals explained in their complaint. An influential factor is the wages paid to hospital employees, which fluctuate based on the cost of living in different geographic areas.
To help compensate for those disparities, HHS annually computes a wage index that compares hospital wages within defined geographic areas to a national average, and adjusts Medicare reimbursements accordingly.
When the wage indices were computed in 2006 and 2007, the geographic boundary lines fell in a way that left three multi-campus hospitals straddling different geographic areas. Those multi-campus hospitals were deemed to be merged facilities operating as a single institution, and thus applied their combined wage data to the wage index for the main provider’s geographic area.
Groups Recommend Early Exposure to Peanuts to Prevent Allergies
A consensus statement developed and endorsed by the American Academy of Pediatrics and the American Academy of Allergy, Asthma & Immunology recommends that “infants at high risk of peanut allergies be given foods containing peanuts before they turn 1.” The recommendations stem from “a major allergy” study published this year that indicated that “exposure to peanuts in infancy seemed to help build tolerance — contrary to conventional thinking.” The statement will be published in Pediatrics.
August 26, 2015
- FDA Drug Shortages
- Aprepitant (Emend) Capsules (Updated – Currently in Shortage)
- Atropine Sulfate Injection (Updated – Currently in Shortage)
- Dexamethasone Sodium Phosphate Injection (Updated – Currently in Shortage)
- Fentanyl Citrate (Sublimaze) Injection (Updated – Currently in Shortage)
- Sufentanil Citrate (Sufenta) Injection (Updated – Currently in Shortage)
Veterans Affairs Report: Still Not Enough Psychiatrists
A report (pdf) from the Department of Veterans Affairs’ (VA) inspector general (IG) http://www.va.gov/oig/pubs/VAOIG-13-03917-487.pdf finds that even after an extensive hiring push, the agency still has an insufficient number of full-time psychiatrists to keep up with demand and current staff is not being used efficiently.
HOME FOR SALE – 500+ ft. of Lighted Cascading Waterfalls
Alongside architect-designed, year-round, custom, one-of-a-kind home on 5.1 wooded acres; 5-deck levels, 90 min to NYC; Catskill Mts. Tiled in-ground pool with full-service cabana. $489,000.For more info, go to www.buyawaterfall.com. Or call 845-647-3914
Pain Medicine Practice For Sale
Near Rochester, NY- Very active and established practice grossing $1,000,000+ on 4 days per week. Income after expenses averages $550-650K+ annually. Fully equipped 2,500 sq. ft. office with 5 exam rooms. Office lease available for extension. This is a “turn-key opportunity” with excellent staff, fully trained. Physician will stay to introduce new practitioner to patients. Contact: Gary N. Wiessen at 631-281-2810 Website: buysellpractices.com or email: email@example.com All inquiries considered strictly confidential.
Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room. Shared secretarial and waiting rooms. Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468 / firstname.lastname@example.org.
Home / Office – Baldwin, Nassau County, South Shore, Long Island 11510
Exceptionally well-built Split Level with 4 floors of living plus a 5-room professional suite on the ground level with a separate entrance. Office consists of a waiting room, Dr.’s consultation office, secretary’s office, 2 examination rooms plus ½ bathroom.
Home offers 3 bedrooms, 2 full plus ½ bathrooms, living room w/ vaulted ceilings, formal dining room, eat-in-kitchen, huge family room with access to a 12×17 outside enclosed porch with bluestone pavers, central air conditioning, gas heat, all hardwood flooring, fireplace, custom crafted bookcases and shelving, full finished basement and a detached 2.5 car garage. Driveway has turn-around ability with ample street parking and a municipal lot across the street. Just minuted to parkway and LIRR. Asking $439, 000. Taxes $12,000. Nancy Scarola Real Estate, Inc. 516-633-5300 Direct Cell or email email@example.com.