Thinking Creatively To Fill Gaps In The Health Care Work Force
Like many states, Texas faces shortages of doctors and other health workers. A conference at the Texas Medical Center explored the research behind several possible solutions, such as “grand-aides” and dental therapists.
http://www.sfgate.com/business/article/Marin-hospital-could-be-first-in-state-to-allow-9216208.php
If Dr. Larry Bedard has his way, Marin General Hospital would become the first acute-care medical center in California to allow patients to openly consume medical marijuana in the hospital.
Patients wouldn’t be allowed to smoke it, since smoking is prohibited. But Bedard, a retired emergency physician at Marin General who now serves on the Marin Healthcare District board, says he knows of no other legally prescribed drug that cannot openly be used by patients in a hospital.
“I know that it happens that it’s being used in the hospital, but it’s ‘don’t ask, don’t tell,’” Bedard said. “It’s kind of wink-and-nod medicine.”
The doctor is taking steps toward bringing it out into the open by introducing a resolution at Tuesday’s board meeting for Marin Healthcare District, which governs Marin General. The resolution, if approved, would direct the hospital’s administrative and medical staff to review and research the clinical and legal implications of using medical marijuana in the hospital and report back to the board.
Bedard initially planned to introduce a resolution to allow patient use in the hospital but stepped back from that last month after the Drug Enforcement Agency declined to remove marijuana from its list of dangerous drugs, keeping it in the same category as such drugs as heroin and LSD.
http://www.sacbee.com/news/politics-government/capitol-alert/article101382077.html
Doctors have long argued that low reimbursement rates are undermining the Medi-Cal system. While more Californians are seeking treatment, the state hasn’t done enough to increase funding to provide care, Corcoran said. Reimbursement rates are not up to par with the cost of practice, making it difficult for physicians to accept Medi-Cal patients, he said.
“It is a broken system,” Corcoran said. “Physicians want to be able to take care of patients. There’s not a lack of desire or a lack of willingness. It’s whether you can actually sustain a practice for all of your patients and provide that level of care that areas need and deserve.”
Medi-Cal is expected to balloon to 14.1 million patients in the current budget year, nearly double the number of Californians using the government-funded health care program four years ago, according to the state. Officials attribute the increase to the federal health care overhaul that expanded subsidized insurance. With a shortage of Medi-Cal doctors, advocates say patients in rural areas and other pockets of the state lack adequate access to care.
During budget talks, the Brown administration has pushed back against the need for rate increases. The administration pointed out that struggling providers can request reimbursement in full and questioned whether higher rates will result in better care.
Issue: One important benefit gained by the millions of Americans with health insurance through the Affordable Care Act (ACA) is protection from high out-of-pocket health spending. While Medicaid unambiguously reduces out-of-pocket premium and medical costs for low-income people, it is less certain that marketplace coverage and other types of insurance purchased to comply with the law’s individual mandate also protect from high health spending.
Goal: To compare out-of-pocket spending in 2014 to spending in 2013; assess how this spending changed in states where many people enrolled in the marketplaces relative to states where few people enrolled; and project the decline in the percentage of people paying high amounts out-of-pocket.
Methods: Linear regression models were used to estimate whether people under age 65 spent above certain thresholds.
Key findings and conclusions: The probability of incurring high out-of-pocket costs and premium expenses declined as marketplace enrollment increased. The percentage reductions were greatest among those with incomes between 250 percent and 399 percent of poverty, those who were eligible for premium subsidies, and those who previously were uninsured or had very limited nongroup coverage. These effects appear largely attributable to marketplace enrollment rather than to other ACA provisions or to economic trends.
http://blogs.wsj.com/washwire/2015/04/16/public-vs-private-health-insurance-on-controlling-spending/
No single fact can settle the long-running debate of whether public or private health insurance is preferable. But by one basic metric, the rate of increase in per capita spending, public insurance has an edge.
A survey found adults in states with a federally facilitated marketplace more likely to be uninsured than those in states operating a state-based marketplace or a partnership marketplace. This indicates another way in which states’ support (or lack thereof) for the ACA has impacted their uninsurance rates.
https://www.cbo.gov/publication/51920
Our analysis of hospitals’ profit margins incorporates the effects of the cuts in Medicare’s hospital payment updates specified in the ACA, other reductions in federal payments to hospitals specified in the ACA and in other recent laws, and demographic changes (which will put downward pressure on hospitals’ margins as more patients shift from higher-paying commercial insurance to lower-paying Medicare coverage). The analysis also incorporates the effects of the expansion of insurance coverage under the ACA, which will improve hospitals’ finances by reducing the number of patients who are uninsured. The analysis focuses on about 3,000 hospitals that provide acute care to the general population and are subject to the reductions in Medicare’s payment updates; it thus excludes most rural hospitals and all of Medicare’s “critical access” hospitals.
As a starting point, we estimated that the average profit margin of the hospitals included in the analysis was 6.0 percent in 2011 and that 27 percent of them had negative profit margins (in other words, they lost money) in that year. That share may be surprisingly high but is similar to the shares of hospitals with a negative annual profit margin over the past two decades. Although some hospitals have closed over that period, others have opened, overall access to care remains good (as measured by indicators such as service use and hospital capacity), and the quality of care may have improved.
Jan Kern was bitten by a stray dog while traveling abroad and ended up with a jaw-dropping illustration of why the U.S. healthcare industry is completely sick.
That’s because she underwent a series of rabies shots in three countries at four medical facilities. What that revealed, and which will surprise no one, is that Americans pay way more for the exact same treatment than people in other nations.
Moreover, her experience highlights the lack of uniformity for drug prices, including commonly used medications. One facility might charge a few bucks for the same drug that costs thousands of dollars at a U.S. hospital.
“There’s no rhyme or reason to our medical system,” said Rick Kern, 61, who contacted me about his 62-year-old wife’s global healthcare adventure after reading my recent column on drug prices.
What’s great about his story as well is that, after I shared it with about a dozen healthcare experts, the consistent reaction was one of utter disbelief. We’re accustomed to shaking our heads at U.S. healthcare costs. Things become significantly more absurd when a couple of overseas medical facilities are stirred into the mix.
“It’s obvious that our system is unlike any other health system,” said Uwe Reinhardt, a healthcare economist at Princeton University. “Other systems were set up to care for patients. Ours was set up by the providers — the hospitals and drug companies — for their own benefit.”
In 1971, President Nixon proposed a national health insurance plan built on heavily employer private coverage. Senator Ted Kennedy proposed what would today be called a single-payer plan. In 1974, the debate had morphed into Nixon vs. Kennedy-Mills vs. Organized labor. Despite the prediction in the second clip shown, the result was stalemate rather than passage in 1974 or 1975.
HENRY KOTULA 