Health Care Reform is Already Happening
by Tom aka “Rusty Rustbelt”
Health Care Reform is Already Happening
Ohio State University Medical Center has built an affiliated physician group of more than 600 physicians. Effective by January 1, 2011, the physicians will be merged into OSUMC (not as medical school faculty) and will be full employees of OSUMC.
OSUMC will do all billing under a consolidated provider number and create a system wide electronic medical record.
This is an “integrated delivery system” (IDS), the strongest trend in health care delivery reform these days.
This is not new, the health care reform discussion in the early 90s created the first major wave of integration. Many of these efforts were massive flops, some worked well and other just cripple along.
Hospitals are not always able to properly manage physician practices, like the skilled driver of an 18-wheeler cannot jump into NASCAR, same concept, much different execution.
An IDS will presumably have much great bargaining power with health insurers, and there is a school of thought that health care costs could actually be driven up.
Without or without action in Washington, health care reform is moving ahead.
HT: Columbus Dispatch
Tom aka “Rusty Rustbelt”
***health care reform is moving ahead.***
Is it reform or just change? It’s easy to confuse motion with progress.
(Not that I’m against doctors working for hospitals as employees.)
The movement toward IDS is consistent with the thinking of many of Obama’s advisors.
Sometimes the government pushes certain reform agendas without b eing overt about it.
But…but…but, how can it be reform if it isn’t routed through government, so a politician can take credit for it…doing the backbreaking work of flapping his/her jaw?
IDS is not a new concept. We have been doing this for various facilities for dozens of years. The problem is, that medical centers and physicians are not doing this for “reform”, this is essentially a self unionization to preserve prices. California right now is investigating price escalations created not by insurers, the popular bad guys, but by providers and institutions. I am a provider in the interest of full disclosure, but many hospitals are combining to “limit the damage”. I am writing a position paper as we speak on the sale of interstate health insurance, and how it will cause prices to rise. Why?, because economically, the insurance companies lose leverage. In cities like Milwaukee, where there are lots of insurance players, and a very competitive market, providers leverage this, and charge higher prices than many other areas with only 1-2 dominant insurance players.
Don’t kid yourselves. This is not being done for patients.
Thanks for pointing out that the Designated Villain(TM) (the health insurance cos.) is not the only (or even the primary) villain.
Somehow the Medical Industrial complex (with the eager acquiesence of DC) has managed to avoid anything resembling responsibility for what is, after all, a f***ing *medical* cost crisis.
But obviously the medicos, nurses unions, and armies of health care administrators/apparatchiks bear no responsibility.
Kind of hard to fix the underlying problem if everyone is wilfully blind to the underlying *cause*.
But by all means let’s hysterically run around to make sure that the obviously underpaid doctors avoid the SGR cut for, what, the ninth year in a row?
***Why?, because economically, the insurance companies lose leverage. In cities like Milwaukee, where there are lots of insurance players, and a very competitive market, providers leverage this, and charge higher prices than many other areas with only 1-2 dominant insurance players. ***
NPR had a very interesting segment on this very thing a year or three ago based on one of the major insurers (Cigna?) pulling out of a number of markets because they didn’t have enough market share in those markets to beat prices down to competetive levels. Yet one more perversion in this shambles we call a healthcare system. Competition encourages monopoly.
A major problem with interstate health insurance is that some insurance companies are just plain sleazy. File claims and they find a way to dump you. Not surprisingly, these tend to be low cost providers. (If you aren’t really selling insurance, you can cut your prices pretty aggressively). Vermont threw a lot of them out a decade ago, and that’s where I’d like those slimeballs to stay … out.
If they ever do implement the SGR, you will see doctors drop medicaid/medicare/Tricare patients as fast as they can. Doubly so in high cost of living areas. Even today you can’t get the best (i.e. most expensive) practices to take these patients. Most doctors actually lose money on these patients, the payment doesn’t cover the overhead. The higher the local cost of living the worse this bias is.
But I did note that Obama got his colonoscapy with a procedure not available to the lowly masses. On the other hand putting him under for this procedure would have put Biden temporaraly in charge, so we probably just dodged a bullet…
Islam will change
In Boston the two major insurance companies and the hospital/provider consortium have an uneasy alliance, but a move to many insurance companies creates a goliath/davids scenario.
this is not reform
this is not new
academic medical centers are big business and they have been trying to find ways
to expand revenues and outpatient health has been a target for some years,
they bought up a lot of pracices in the 90s but the drive stalled
Health IT provides thjem with another opportunity to spread their net and get independent physicians into their revenue stream
The bad part about integerated systems tha you deal with one big entity and that entity might be the only one in your area. It’s a little hard to shop around to drive down down costs when there is only one provider in town.
***If they ever do implement the SGR, you will see doctors drop medicaid/medicare/Tricare patients as fast as they can. Doubly so in high cost of living areas.***
Of course. But it may not happen for a reason that you might not expect. Our healthcare system is disintegrating so fast that if Sustainable Growth Rate pricing gets held off for another five years or so, doctors may well be faced with a choice of SGR priced patients or no patients.
I imagine that will eventually devolve into Japanese style health care. Assembly line medicine. Wait three hours. Answer the wrong questions for about five minutes and scoot off with a prescription for a drug, or a placebo, or something. It won’t be as cheap or effective as Japan which somehow manages to keep their population pretty healthy. But it’ll pay the med school loans and country club memberships …. at least for a while.
I’d suggest to all Americans that if they are planning to have medical problems and have health care coverage at the moment, they’d be well advised to get sick now and not put it off.
On this topic, you and I are in complete agreement. On my blog, I postulated….
“How about this idea. If we are going to mandate that all patients have insurance, and we are going to mandate that all insurance companies cannot deny pre-existing conditions, or cancel policies, and must have higher MLR ratios, then how about MANDATING that all providers accept Medicare patients. Tie it to their DEA number. If they refuse to see new Medicare patients, they lose their DEA number.
Providers need to have some skin in the game too.”
I’m waiting for the nastygrams now.
I suupose remaining solvent could be viewed as patient-oriented, or just greedy self-interst, or a combination.
I have severe doubts about IDS, some work, some are train wrecks. And I have never trusted hospital execs much. IT tends to leave rural areas in a lurch.
We are headed this direction (aqain!) for a number of reasons, for better or worse.
As you know this requirement will fall more heavily on some specialties, someof which is to be expected.
The new-maybe SGR gives a little boost to family practice, but not much.
I’ve been thinking of oysters and their essence to higher mammals.
IDS is as old as: charitable hospitals; which is pretty much what existed as a health delivery system before the advent of the Medical-Insurance Complex. Actually a complex much larger and better at pillaging the US economy than the militarist version.
Then as governments got bigger there came about public health services, driven to stop epidemics, promote public hygiene (“Marguerite go wash your feet the board of….”) and eugenics in the late 19th century. But then US workers were the bane of European workers and the health of the work force was an issue likely to be seen in Chnia soon.
After the US War Between the States a system of military hospitals arose which cyclically grew and flourished until the mid Cold War when the Medical-Insurance Complex learned by using CHAMPUS and now TRI CARE how to plunder soldiers as good as the Mitilarist Industrial Complex did the citizens and soldiers.
There likely are not enough military medical centers left nor medical units to treat the casualties in a half sized small war much less one big one or a going small war, not to be confused with occupation duty as today.
IDS works but like military arsenals the concentration of money destroys good.
But the two MIC’s are not going to allow the revenues to decline, and will scream bloody murder if there growth plans do not increase their take of the GDP.
All that said, IDS does not affect the issue of health delivery as a human right, and why the state has to “insure” or deliver Medical Industry Complex services at huge costs to the poor, the ill and the aged.
If those groups need the state because the MIC is not serving them then the MIC’s need to be abolished.
“The time has come” the walrus said “to spreak of many things; of cabbages and kings, and whether the sea is boiling hot, and whether pigs have wings………………”
Too bad everyone is off this thread.
Of course price fixing in medicine is bad, it is the gravest evil to take away a doctor’s rigth to plunder a sick person particulaly one whose pain needs to be relieved or whose life is threatened.
And certainly it is bad for the gumint to force insurers to open the betting parlor to all, and stop betting with only young, pretty, healthy, rich or employed people that all these low risker will get sick.
It is even more dastardly that the big bad gumint replace these fine gambling parlors skimming off 2 or 3% of GDP to deliver shoddy health outcomes.
Why pay taxes when the insurers can charge you and make good profits?