March 2011

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Health Wonk Review – Opening Day Edition

March 31, 2011 in Carnivals | 14 comments

Today is opening day. The first day of the season where the Milwaukee Brewers will win the World Series. In honor of opening day, I’ve put together an all-star team of health wonk blog posts. To find out more information about a baseball player, you typically examine his statistics.  To find out more information about the riveting health policy questions posed below, simply click on the link.

It’s time for some baseball Health Wonk Review fever.  Enjoy!

Starting Lineup

Bullpen

Awards

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Pay College Players: Part II

March 30, 2011 in Current Events | No comments

In a post last week in honor of the NCAA tournament, I mentioned that universities should start paying college players. It looks like this is already happening:

“Four former Auburn football players say in an ‘HBO Real Sports’ report scheduled to be broadcast Wednesday night that they were paid thousands of dollars during their college careers, including one who said he received money from an assistant coach.

One of the players, Stanley McClover, also said he received money while on recruiting visits to Michigan State and Ohio State and while attending an all-star camp at Louisiana State. He originally committed to play for Ohio State but said he changed his mind when he asked for and received money from Auburn.”

Wouldn’t a transparent process to compensate players be more fair and honest than these under the table dealings?  Should college athletes be demonized for wanting to share in the future profits they generate for  universities?

The Fiesta Bowl’s CEO is certainly not shy about receiving compensation.

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Is there really large differences in Medicare Spending across states?

March 30, 2011 in Health Reform, Medicare, Supply of Medical Services | 2 comments

Research by the Dartmouth Atlas team has indicated that Medicare spending is concentrated regionally.  States such as Florida spend much more per beneficiary than do doctors who treat similar patients in low cost states like Minnesota.

A recent paper by Reschovsky and co-authors, however, has determined that variation in supply-induced demand is not a major driver in regional variation in health care costs once one controls for health status at the beneficiary level.  Read more to find out how the authors came to this conclusion.

Read the rest of this entry »

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What are QIOs

March 29, 2011 in Medicare, Quality | No comments

According to the CMS website, Quality Improvement Organizations (QIOs) are private, mostly not-for-profit organizations, which are staffed by professionals, mostly doctors and other health care professionals, who are trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care. CMS contracts with one organization in each state, as well as the District of Columbia, Puerto Rico, and the U.S. Virgin Islands to serve as that state/jurisdiction’s QIO contractor.

QIO’s core functions include:

  • Improving quality of care for beneficiaries;
  • Ensuring that Medicare pays only for reasonable and necessary services and goods in the most appropriate setting; and
  • Addressing individual complaints, such as beneficiary complaints; provider-based notice appeals; violations of the Emergency Medical Treatment and Labor Act (EMTALA) [EMTALA requires hospitals and ambulance services to provide care to anyone needing emergency services.]
  • On February 2, 2011, CMS published a proposed rule that would require most Medicare-participating providers and suppliers to give Medicare beneficiaries written notice about their right to contact a Medicare Quality Improvement Organization (QIO) with concerns about the quality of care they receive under the Medicare program.

Examples of work the QIOs perform includes:

  • The Federal Doctor’s Office Quality Information Technology initiative (DOQ-IT).  This initative promotes the adoption of electronic health record systems and information technology in small-to-medium sized physician offices with a vision of enhancing access to patient information, decision support, and reference data, as well as improving patient-clinician communications.
  • Surgical Care Improvement Project (SCIP). This hospital based quality improvement initiative led by CMS that focuses on reducing the rate of adverse outcomes of common surgical procedures..

History

According to Zeitler (2004), Peer Review Organizations (PROs)) were established through the Peer Review Improvement Act of 1982 (a part of the Tax Equity and Fiscal Responsibility Act of 1982), replacing Professional Standards Review Organizations (PSROs) that had been established in  1972. In FY2002, they were renamed Quality Improvement Organizations (QIOs).

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Will There Be Enough PCPs To Treat New Medicaid Patients?

March 28, 2011 in Health Reform, Medicaid, Physician Compensation, Supply of Medical Services | 1 comment

One of the key components of health reform is expanding Medicaid eligibility to more individuals.  My comments on the Health Reform provisions were expanded Medicaid coverage was that it was just taking the same poor system and expanding the coverage to more people.  However, the cost of these additional people may be lower if they are healthier and wealthier than the previous cohort of Medicaid enrollees.  Further research shows the cost for these new Medicaid beneficiaries may be even lower still: there may not be enough primary care physicians (PCPs) to treat all these new patients.

According to an article from WSJ:

“A study out this week from the Center for Studying Health System Change (CSHSC) comes to a sobering conclusion: in most areas of the country, growth in Medicaid enrollment will “greatly outpace” growth in the number of primary-care doctors who accept the joint federal-state insurance program.

…Physician groups and policy-makers have been warning for years — well before the Affordable Care Act was even a gleam in President Obama’s eye — that we are facing a shortage of physicians in general, and particularly of primary-care doctors.

…the American College of Physicians warned that despite the “positive sign” of an increased interest in internal medicine residencies, “the U.S. still has to overcome a generational shift that resulted in decreased numbers of students choosing primary care as a career.”

But Medicaid patients have an additional hurdle: in 2008, only 42% of U.S. primary-care doctors accepted new patients covered by the program, due to its low reimbursement rates and other factors. By contrast, 61% of primary-care doctors reported accepting new Medicare patients and 84% accepted all or most privately insured patients, according to CSHSC.”

The lesson is that simply expanding insurance coverage is not the same as improving the quality or quantity of medical care.

 

 

Friday Links

March 25, 2011 in Current Events | No comments

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Health Care Research Awards

March 24, 2011 in Economics - General | No comments

The National National Institute for Health Care Management (NIHCM) recently selected its five finalists for their Annual Health Care Research Award.  These studies include the following:

 

 

 

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Disaster Management

March 24, 2011 in Public Policy | No comments

Natural disasters such as earthquakes, hurricanes, and tornados are some of the most devastating events any city can endure. These disasters compromise the health of many residents due to lack of food and clean water, injuries and contagious diseases.  For most of the history of the U.S., federal assistance to communities hit by diasters took the form of one-time appropriations from Congress.

As the Wilson Quarterly notes, however, after the great depression, federal agencies were formed to help out these unfortunate communities.  Federal efforts include the creation of the Reconstruction Finance Corporation in 1932.  ”The Federal Civil Defense Administration was created to help the country in the case of nuclear war, but, in part thanks to pressure from state and local governments, they soon became key instruments in responding to natural disasters.”  In 1979, Congress created the Federal Emergency Management Agency.  This act consolidated various disaster-response programs throughout the government.

Patrick Roberts argues in a 2010 National Affairs article that it may be time for the White House to back off from disaster management.  At the state an local levels, politicians hope that disasters look horrible on television to generate more FEMA money.  Roberts argues that the government should steer development away from disaster prone areas and should delegate disaster relief to the state and local level.

This is not as easy as it sounds however.  FEMA’s National Flood Insurance Program (NFIP) likely underprices premiums for flood insurance and thus encourages development on flood plains.  Many libertarians would ask the private market to perform such as task.  Private insurance companies, however, do not like this type of insurance since the risk is correlated. In the automobile insurance market, being involved in a car accident has a small effect on the probability my neighbor has a car accident. In the disaster insurance market, however, the probability I experience a disaster is very high if my neighbor has experienced a disaster.  Thus, insurance companies who provider coverage within a narrow geographic area are at risk for insolvency if a serious natural disaster strikes.  Nevertheless, I generally support delegating more emergency management operations to the state and local level.

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What is the difference between GDP, GNP, and National Income?

March 23, 2011 in Economics - General | No comments

Gross Domestic Product (GDP), Gross National Product (GNP), and National Income measures attempt to measure how much economic activity took place during a specified amount of time (usually a year).  Yet many people do not know the difference between these measures.  Today, I’ll briefly review these differences by describing how they are calculated by the Bureau of Economic Affairs.

  • GDP mesausre the market value of all final goods and services produced within a country in a given period of time.
  • GNP measures the market value of all final goods and services produced by a country’s citizens or residents.  The difference is subtle but improtant.  GNP excludes economic activity that occurs in the U.S. but is owned by foreigners and includes American economic activity that occurs in other countries.  GDP is place based whereas GNP is ownership based.  Thus, if a foreigner creates an internet startup in Silicon valley, this will count as GDP, but not GNP.  If General Electric opens a new plant in Poland, this investment will be included in GNP, but not GDP.
  • National Income.  National income is equal to GNP less the consumption of fixed capital (i.e., depreciation).
  • Personal Income measures the amount of income available to individuals in terms of funds on hand.  Personal income equals to national income less: corporate profits with inventory valuation and capital consumption adjustments, contributions for government social insurance, domestic net interest and miscellaneous payments on assets, net business current transfer payments, current surplus of government enterprises, undistributed wage accruals. Added to net national income are personal income receipts on assets and personal current transfer receipts.

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CoR #127

March 23, 2011 in Carnivals | 1 comment

The latest edition of the Cavalcade of Risk is up at My Personal Finance Journey.

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