Health Wonk Review: September

Nothing to be ashamed of

Welcome to the September 11, 2014 edition of the Health Wonk Review. We’ve got a hearty and healthy set of posts from our wonkish community, including submissions on Obamacare, Medicare, performance measurement and power plants.

Medicare anyone?

In The 125 percent solution, Health Affairs bloggers including Elliot Fisher suggest using Medicare as the benchmark for all payments to providers.

“If every patient and every insurance company always had the option of paying 125 percent of the Medicare price for any service, we would effectively cap the worst of the price spikes. No longer would the tourist checked out at the ER for heat stroke be clobbered with a sky-high bill. Nor would the uninsured single mother be charged 10 times the best price for her child’s asthma care.”

Meanwhile, Healthcare Lighthouse informs us that CMS is slowly integrating principles of bundled payment into the base fee-for service hospital reimbursement system. The Medicare Services per Beneficiary (MSPB) measure essentially creates a virtual bundled payment episode for every hospital admission.

Healthcare policy experts know that the Resource Based Relative Value Scale Update Committee (RUC) is a big reason why US specialist physicians are overpaid and procedures so richly rewarded. Medicare generally accepts the RUC’s recommendations and commercial payers blindly follow. Yet no journalists seem able to stir up sufficient attention to this secretive group, which has only gotten less independent over time. Health Care Renewal shares the lament with us.

Obamacare: Con and Pro

In a three-part video interview, Curbside Consult Host Harold Pollack talks with conservative health policy wonk and former Romney advisor Avik Roy about his “universal exchange” health reform plan, “Transcending Obamacare.”

InsureBlog never met an Obamacare-causes-new-problems story it didn’t like, and this week’s entry is no exception: Tax forms will be more complex thanks to Obamacare subsidy calculations.

Heading back to school so you can get a good job? Not so fast. John R. Graham says the Affordable Care Act is affecting your odds of getting full time employment.

While well-insured armchair Obamacare opponents talk of transcendence and throw a scare into schoolgoers, Healthbeat explains why 10 million more people will gain insurance coverage in 2015 and why those who have had direct experience with Obamacare are more likely to support it than those who have only read about it.

Medical cost inflation continues to decline, reports Managed Care Matters. That’s good news for those paying the bills and not as good for those raking in the cash (and for health reform opponents who have to work harder on their arguments against Obamacare).

Get fatty

Put down that donut! Workers Comp Insider posts about a recent report on the status of obesity in America from the Trust for America’s Health and The Robert Wood Johnson Foundation. More than a third of adults are obese and more than two-thirds when factoring in “overweight.” Insider also links to various reports on the relationship of obesity to workers comp.

What Would Cigna do?

Wright on Health examines Christian medical cost-sharing plans, which allow people to be exempted from the ACA’s individual mandate to purchase health insurance, but which are themselves not really health insurance—despite looking a lot like it. How many people enroll in a plan like this without fully understanding what they’re buying, and how little protection they may actually have?

Does spanking work?

Wing of Zock addresses the often unintended consequences of carrot-and-stick performance measures, of which the recent VA scandal is a regrettable example. Performance measurement is especially difficult in pediatrics, but is essential to tracking outcomes. “Problems begin when performance measures cease to become a means to an end, and become an end unto themselves.”

Power to the people

Population Health Blog takes note of the many eerie parallels between the power-utility industry and health care. Will there be a smokestack casting a shadow on your favorite integrated delivery system? (I’m not holding my breath, but maybe I should)

That’s it for this edition. Thanks for reading!

photo credit: @jbtaylor via photopin cc