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Monthly Archives: February 2018
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Podcast: ‘What The Health?’ The State Of The (Health) Union
https://khn.org/news/podcast-what-the-health-the-state-of-the-health-union/
In his first State of the Union Address, President Donald Trump told the American public that “one of my greatest priorities is to reduce the price of prescription drugs.” But that message could barely begin to sink in before other health news developed: The director of the Centers for Disease Control and Prevention was forced to resign Wednesday after conflict-of-interest reports.
Meanwhile, outside the federal government, Idaho is proposing to allow the sale of individual insurance policies that specifically violate portions of the Affordable Care Act. And three mega-companies — Amazon, Berkshire-Hathaway, and JPMorgan Chase — say they will partner to try to control costs and improve quality for their employees’ health care.
This week’s “What The Health?” panelists are Julie Rovner of Kaiser Health News, Alice Ollstein of Talking Points Memo and Julie Appleby and Sarah Jane Tribble of Kaiser Health News.
Among the takeaways from this week’s podcast:
- Despite Trump’s strong rhetoric in the State of the Union Address, the president has taken few actions during his first year in office to reduce drug prices.
- The president touted that Republicans had repealed the health law’s requirement that individuals get health insurance or pay a penalty. But that change in the law doesn’t go into effect until 2019, so his comments could be confusing to some taxpayers.
- Idaho officials have announced that they are going to allow insurers to issue policies that don’t meet all the criteria of the federal health law. But it’s not clear that insurers are interested in participating in the experiment.
- “Alexa, send me my Lipitor!” Can Amazon’s announcement that it and two other corporate behemoths are taking on employees’ health care create a new formula for keeping costs down and improving quality?
Unnecessary Medical Care: More Common Than You Might Imagine
It’s one of the intractable financial boondoggles of the U.S. health care system: Lots and lots of patients get lots and lots of tests and procedures that they don’t need.
Women still get annual cervical cancer testing even when it’s recommended every three to five years for most women. Healthy patients are subjected to slates of unnecessary lab work before elective procedures. Doctors routinely order annual electrocardiograms and other heart tests for people who don’t need them.
That all adds up to substantial expense that drives up the cost of care for all of us. Just how much, though, is seldom tallied. So, the Washington Health Alliance, a nonprofit dedicated to making care safer and more affordable, decided to find out.
CALLOUT:
Have you worked in the health insurance industry? You have expertise that could help ProPublica’s reporting. Please share your insights with Marshall Allen to help him learn about the industry.
The group scoured the insurance claims from 1.3 million patients in Washington state who received one of 47 tests or services that medical experts have flagged as overused or unnecessary.
What the group found should cause both doctors, and their patients, to rethink that next referral. In a single year:
- More than 600,000 patients underwent a treatment they didn’t need, treatments that collectively cost an estimated $282 million.
- More than a third of the money spent on the 47 tests or services went to unnecessary care.
- 3 in 4 annual cervical cancer screenings were performed on women who had adequate prior screenings – at a cost of $19 million.
- About 85 percent of the lab tests to prep healthy patients for low-risk surgery were unnecessary — squandering about $86 million.
- Needless annual heart tests on low-risk patients consumed $40 million.
Susie Dade, deputy director of the alliance and primary author of the report released Thursday, said almost half the care examined was wasteful. Much of it comprised the sort of low-cost, ubiquitous tests and treatments that don’t garner a second look. But “little things add up,” she said. “It’s easy for a single doctor and patient to say, ‘Why not do this test? What difference does it make?'”
ProPublica has spent the past year examining how the American health care system squanders money, often in ways that are overlooked by providers and patients alike. The waste is widespread – estimated at $765 billion a year by the National Academy of Medicine, about a fourth of all the money spent each year on health care.
The waste contributes to health care costs that have outpaced inflation for decades, making patients and employers desperate for relief. This week Amazon, Berkshire Hathaway and JPMorgan Chase rattled the industry by pledging to create their own venture to lower their health care costs.
Wasted spending isn’t hard to find once researchers — and reporters — look for it. An analysis in Virginia identified $586 million in wasted spending in a single year. Minnesota looked at fewer treatments and found about $55 million in unnecessary spending.
Dr. H. Gilbert Welch, a professor at The Dartmouth Institute who writes books about overuse, said the findings come back to “Economics 101.” The medical system is still dominated by a payment system that pays providers for doing tests and procedures. “Incentives matter,” Welch said. “As long as people are paid more to do more they will tend to do too much.”
Dade said the medical community’s pledge to “do no harm” should also cover saddling patients with medical bills they can’t pay. “Doing things that are unnecessary and then sending patients big bills is financial harm,” she said.
Officials from Washington’s hospital and medical associations didn’t quibble with the alliance’s findings, calling them an important step in reducing the money wasted by the medical system. But they said patients bear some responsibility for wasteful treatment. Patients often insist that a medical provider “do something,” like write a prescription or perform a test. That mindset has contributed to problems like the overuse of antibiotics — one of the items examined in the study.
The report may help change assumptions made by providers and patients that lead to unnecessary care, said Jennifer Graves, vice president for patient safety at the Washington State Hospital Association. Often a prescription or technology isn’t going to provide a simple cure, Graves said. “Watching and waiting” might be a better approach, she said.
To identify waste, the alliance study ran commercial insurance claims through a software tool called the Milliman MedInsight Health Waste Calculator. The services were provided during a one-year period starting in mid-2015. The claims were for tests and treatments identified as frequently overused by the U.S. Preventive Services Task Force and the American Board of Internal Medicine Foundation’s Choosing Wisely campaign. The tool categorized the services one of three ways: necessary, likely wasteful or wasteful.
The report’s “call to action” said overuse must become a focus of “honest discussions” about the value of health care. It also said the system needs to transition from paying for the volume of services to paying for the value of what’s provided.
Broward Health offers CEO job to indicted interim leader
http://www.sun-sentinel.com/local/broward/fl-sb-broward-health-ceo-meeting-20180130-story.html
The board of Broward Health rejected all four finalists for the chief executive officer’s job Wednesday and voted to give it to their current interim CEO, Beverly Capasso, who is under indictment.
Capasso, who earned $650,000 a year as interim CEO, faces criminal charges along with four other current or former Broward Health leaders over alleged violations of Florida’s open-meetings law in the firing of a previous interim CEO. But board members said she has done an excellent job restoring stability to the organization, with several strong hires in executive positions, and that none of the four finalists turned out to be the stellar candidate with whom they had hoped to fill the job.
At the meeting, none of them mentioned the indictments, focusing instead on Capasso’s efficiency in beefing up the system’s managerial ranks, its improved finances and the apparent end of the crises that had plagued it.
“I think she’s done an amazing job and has an amazing team,” said board member Steven Wellins.
The job of leading the five-hospital, taxpayer-supported system came open more than two years ago, when its last permanent CEO killed himself with a bullet to the chest. Since then, the system has been run by a series of interim leaders, as the board, which is appointed by Gov. Rick Scott, lurched from one hiring process to another, creating instability that affected everything from employee morale to the system’s bond rating.
The vote was 4 to 1 to give the job to Capasso, with board chairman Rocky Rodriguez dissenting from an action that he said would “corrupt the process” of hiring a new leader.
Nancy Gregoire, the newest board member, made the motion to offer Capasso the job, saying she would hold the position until the expiration of a federal oversight agreement, expected some time late in 2020. By then, she and other board members said, they hope Broward Health will have a strong enough national reputation to attract higher-quality CEO candidates.
Gregoire said in an interview that the indictment was a concern, but that the charges were only second-degree misdemeanors and that Capasso should be considered innocent until proven guilty.
“Certainly it bothers me,” she said. “However, I really believe that the four candidates we had to review were not the best thing for Broward Health right now. I’d hate to make a mistake and make matters worse.”
Several board members pointed to the mediocre scores the four finalists received from executives of Broward Health’s hospitals, who had met with the finalists. Their scores ranged from 1.7 to 2.9 on a 5-point scale.
Capasso, a registered nurse, rose through the ranks to become a hospital executive, eventually becoming chief executive of Jackson Memorial Hospital in Miami.
The job description distributed by Broward Health says the CEO position requires a master’s degrees. Capasso has one in health administration, but it’s from a defunct mail and online institution called Kennedy-Western University that federal investigators identified as a diploma mill, an institution that confers degrees for little or no academic work.
Former Broward Health board member Joseph Cobo denounced the decision to hire her. There’s talk that the whole process was a “sham,” he said, and that the plan was always to give Capasso the job.
“I have never, ever, in the 40 years I’ve been around this place, seen a staff more scared from the retaliation that has been occurring,” he said. “You need a change. Yes, there are some very good people in this organization. But a lot of people have been hurt.”
Capasso, a former Broward Health board member who lives in Parkland, was indicted along with Rodriguez, board member Christopher Ure, former board member Linda Robison and general counsel Lynn Barrett for allegedly violating the state’s open-meetings law in the secretive manner in which they handled the investigation and firing of previous interim CEO Pauline Grant. All have denied wrongdoing. The cases are pending.
The firing of Grant, one of the county’s highest-ranking black officials, gave a racial tinge to the debate over the CEO job, with many black leaders denouncing the move. But at the meeting Wednesday, five black clergymen, some of whom had criticized the board in the past, spoke in favor of giving the job to Capasso.
“From my understanding of talking with different individuals and having real heart-to-heart conversations, I think the current interim CEO and the team that she’s put together is taking the ship in the right direction,” said Pastor Allen B. Jackson, of Ark Church of Sunrise. “I think they are doing a great job bringing the ship through the storm and taking the ship where it needs to go.”
In explaining his opposition, board chairman Rodriguez said he didn’t believe in springing something at the 11th hour and that there had been an explicit and public understanding that Capasso would serve only on a temporary basis.
“We made a promise to this community that this was not going to happen,” Rodriguez said.
“But we’ve heard from the community,” Gregoire said.
“Well, they’re part of the community,” Rodriguez responded. “With all due respect, they’re a huge part of the community, but there’s other people in the community that are not here.”
Capasso was not present at the meeting, which was a special meeting called just to discuss the CEO issue. But she was in attendance at the subsequent regular meeting, where she said she would accept.
“I’m humbled and honored to accept the terms of the contract,” she told the board. “We have stabilized Broward Health. We will continue to stabilize Broward Health for our patients, our community and the 8,000 employees of Broward Health.”
House GOP warming to ObamaCare fix
Key House Republicans are warming to a proposal aimed at bringing down ObamaCare premiums, raising the chances of legislative action this year to stabilize the health-care law.
House GOP aides and lobbyists say that top House Republicans are interested in funding what is known as reinsurance. The money could be included in a coming bipartisan government funding deal or in another legislative vehicle.
Any action from Republicans to stabilize ObamaCare would be a major departure from the party’s long crusade against the law, but after having failed to repeal the Affordable Care Act last year, the discussion is shifting.
Rep. Ryan Costello (R-Pa.) is one of the leaders of the push in the House and is sponsoring a bill to provide ObamaCare stability funding in 2019 and 2020. He notes the relatively short-term nature of his measure.
“That reflects the political reality that we are not going to be doing some large, sweeping health-care bill in the next year,” said Costello, who faces a competitive reelection race this year.
“I am optimistic that it would be under serious consideration for inclusion in the omnibus,” he added.
Speaker Paul Ryan (R-Wis.) noted the possibility of action on an ObamaCare stability measure, particularly funding for reinsurance, at an event in Wisconsin in January, saying he thought there could be a “bipartisan opportunity” on the issue.
Action on the reinsurance payments is far from certain; conservative opposition to what some view as a bailout of ObamaCare insurers could stop the proposal in its tracks. But there is growing momentum for the idea, and Republicans said the proposal would likely be discussed more at the GOP retreat this week in West Virginia.
The push on reinsurance matches up with one of the ObamaCare bills that Sen. Susan Collins (R-Maine) has been pushing in the Senate.
Senate Majority Leader Mitch McConnell (R-Ky.) gave Collins a commitment to support a reinsurance bill as well as another stability measure from Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) in exchange for Collins’s support for tax reform in December.
Opposition in the House has always been the major impediment to those measures moving forward. But it now appears some of that resistance is softening, at least on the reinsurance measure, now that Republicans have repealed ObamaCare’s individual mandate through the tax bill.
Importantly, House Energy and Commerce Committee Chairman Greg Walden (R-Ore.), whose panel has jurisdiction, is supporting the ObamaCare stabilization efforts and backs Costello’s bill.
“Chairman Walden is supportive of Rep. Costello’s efforts to help states repair their insurance markets that have been damaged by Obamacare,” an Energy and Commerce spokesperson wrote in an email. “Rep. Costello’s bill is a fair approach to granting states greater flexibility to help patients and lower costs.”
Rep. Cathy McMorris Rodgers (R-Wash.), the fourth-ranking Republican in House leadership, is also a co-sponsor of Costello’s stabilization bill.
While House conservatives have opposed propping up ObamaCare, Rep. Mark Meadows (R-N.C.) did not dismiss the payments out of hand on Tuesday.
“If it lowers premiums, I’m willing to listen to any ideas,” said Meadows, who is chairman of the House Freedom Caucus.
He warned that he did not want a proposal to be an “insurance bailout,” but noted that he has been talking to colleagues in the House and Senate about the issue.
Another obstacle for an ObamaCare fix is a dispute over abortion. Republicans are adamant that a stabilization measure must include restrictions on the new funding being used to cover abortion services, a notion that is problematic for Democrats.
Reinsurance funding is used to help insurers cover the costs of especially sick patients, which helps relieve pressure on premiums for the broader group of enrollees.
The other main stabilization measure, from Alexander and Murray, would fund ObamaCare payments that reimburse insurers for giving discounts to low-income enrollees, known as cost-sharing reductions (CSRs).
Republican sources say there is less momentum in the House for funding CSRs than there is for the reinsurance measure. But even some Democrats are now questioning whether funding CSRs still makes sense, given that through a quirk in the law, President Trump’s cancellation of the payments last year actually led to increased subsidies and lower premiums for many enrollees.
Rep. Phil Roe (R-Tenn.), for example, a leading House Republican on health-care issues as co-chairman of the GOP Doctors Caucus, said Tuesday that he feels negatively about the idea of funding CSRs but likes the idea of reinsurance.
Roe pushed back on the idea that the funding would be propping up ObamaCare, saying that the repeal of the individual mandate had changed the discussion because people no longer were forced to buy coverage.
Roe said he runs into people in his district paying more than $1,000 per month in premium costs.
“We’re going to have to do something,” he said.
8 ‘Soft’ Interview Questions Applicants MUST Master
Job candidates cannot show up to an interview, develop answers to questions on the fly, and expect to succeed, especially when it comes to the so-called softball questions they should be able to hit out of the ballpark.
Preparation by candidates, which recruiters say is lacking, is a major reason otherwise qualified executives are not advanced in a search.
In our second big idea of Wednesday’s podcast, “The Decline In Candidate Soft Skills, Questions You Should Kill,” we looked at a Fast Company article “How You Can Prepare for These Common Interview Questions” by freelance writer Isabel Thottam. We reviewed six important questions she included in an article for Glassdoor that many candidates simply soldier through as if they are not that important. In reality, the answers to those questions count a great deal.
Here are eight more so-called soft issue questions that Ms. Thottam believes candidates should pay attention to, and for which to prepare killer answers:
- Tell me about a conflict you faced at work and how you dealt with it? This is one of the soft skill questions designed to zero in on how you do things. This is an answer, Ms. Thottam says, that you should ace because your answer will reveal how you deal with conflict and how adept you are at thinking on your feet, both important skills, especially for executives. Prepare in advance ( a recurring theme here), succinctly state the issue, provide a brief but complete answer and end on a positive note.
- What is your dream job? This is all about how realistic you are at setting goals (short-term and long-term), planning and whether you will fit with the organization over the long term. Be sure your answer focuses squarely on career goals and how this job will advance your quest. By the way, it is not only cheesy but bad form to answer “CEO of this company.” A fellow recruiter once quipped, “That is a winning answer about one time in a 100.”
- What do you expect out of your team and coworkers? The underlying reason for this question is all about culture, how you work on a team and whether your style will be a good fit. Ms Thottam recommends, and I concur, that to prepare for this type of question applicants should look at social media profiles of the organization or read reviews at Glassdoor.
- What do you expect from your manager? This question also is focusing in on soft skills — your emotional intelligence, and whether you will fit with the team. Be honest. It is important to use some relevant examples from past jobs.
- How do you deal with stress? This, too, is a culture-based question, Ms. Thottam writes. No manager wants a drama queen, constant complainer or a serial jerk on their team. Stressful situations typically will expose some of those negative tendencies. Managers are looking for people who can effectively work through difficult periods to accomplish goals. Provide specific examples of how you relieve stress during the workday and emphasize your effectiveness in completing assignments in a timely manner during these times. Site examples but be brief.
- What would the first 30 days in this position look like for you? Not to beat the drum too much, but careful preparation of an answer for this question can go a long way in establishing your “favorability” score. Companies, now more than ever, need employees who can get up to speed as soon as possible. While corporate onboarding programs designed to ensure just that are gaining favor as part of an effort to improve employee engagement, they are not widely in use. Ms Thottam writes that candidates should ask during the interview about performance deliverables, how the manager will define success in a year and, when this question comes up, ask for information on what will be needed to get started as well as those things needed to help transition into the new position.
- What are your salary requirements? This question has “locked up” more candidates than you can possibly imagine. Ms. Thottam explains that this question is not always asked but it is best to be prepared for it. I am prejudiced on this issue based on my work with senior level executives. At that level we give them the salary range up front so as to avoid wasting anyone’s time. I find it astounding how many internal executive recruiters do not reveal that information, and how many candidates do not ask. That don’t ask, don’t tell approach can lead to some embarrassing moments in a search, and a lot of wasted time. At entry level, in searches for supervisors or managers, I can see how this might not be discussed but certainly at the senior executive level my advice is to state your current base salary and any bonus or incentive pavement plans. Do not exaggerate. When explaining your salary, state the current base, the percentage potential for incentives and your total cash earnings in the last full fiscal year. Do not get cute and factor in non-cash awards in an effort to negotiate a better deal. For lower level employees and managers, there are tools on sites like Glassdoor that can help you determine your compensation worth. Remember, the lower you are in the organization, the less negotiation there will be on compensation.
- Do you have any questions? Not having questions is more often than not, a negative for the candidate. Saying they have already been answered is lame so think about multiple questions you want to know about in advance, or make notes of questions that come up during the day.
One more thing, do your homework and be prepared.
HENRY KOTULA 