Tuesday, May 1, 2012

May Day!

Happy May Day!  The coming of spring, the tantalizing tease that leads us into summer.  Today, I begin interviewing 15 lawyers for our staff attorney position.  I have 7 interviews scheduled today, leaving very little, if any, time for actual work.  A little stressful, to say the least!  But I have no doubt that someone will rise to the occasion and be right for us.  Indeed, I'm sort of excited to pick someone with energy and enthusiasm about what we do.

But first, the news -- and it's Tuesday, which means it's a big health news day.  Let's see ....

The Governor of Minnesota is trying to move forward with health reform implementation without the support of the state legislature, which is dominated by anti-reform Republicans.  Similar stand-offs are occurring in several states.  In New York -- not exactly a conservative bastion -- Governor Cuomo has created an Exchange by executive order because he couldn't get it through the legislature.  If the law survives the Supreme Court, the federal government will operate Exchanges in states that won't do it themselves, which isn't a desirable outcome for anybody.  Exchanges are marketplaces where people will be able to shop for and buy insurance.  You can be against aspects of reform and still be in favor of creating smarter consumers.  You consumers should be making a fuss if your state is not moving towards an Exchange. 

What happens if the Supreme Court strikes down the law?  The GOP is split on how to replace health reform.  It's not looking good for coverage of pre-existing conditions. Tax credits.  They want to give us tax credits.  As if that's going to be available to pay the doctor or the pharmacy.  They can't even agree on whether young adults to age 26 should be able to stay on their parents' policy.  For those who are against reform, be careful what you wish for.  Reform has saved seniors $3.4 billion in prescription drugs.  And that's bad because.....?

Meanwhile, Massachusetts is looking at phase two of reform, payment reform.  They've achieved near universal coverage; the next step is to control cost, and so they are launching a new payment methodology that would pay a global payment rather than a flat fee for services performed.   They would get a payment covering a group of patients and focus on health outcomes.  Bonuses are earned by the success of treatment.  I'm not sure how it will work, but it's intriguing -- I need to learn more about this.

Patients present at the emergency room with dental pain seeking narcotics.  Is it for real or are they drug seeking?  Pain meds are prescribed in 3 of 4 ER visits.  Some of them need pain meds, for sure.  But how does an ER doctor know whether the patient is in real pain or if they are drug seeking.  Some err on the side of treating, but I hear stories all the time of people being sent away with nothing.  Hard decisions -- we don't need to create a bunch of addicts.  One of these days, we'll find a way to test people for pain.  Until then, I say I'd have to go with my gut and err on the side of treating.  Tough choices, though.  Meanwhile, the number of women who give birth while addicted to opiates, producing addicted babies, is soaring.  This is tragic; the poor babies, born into drug withdrawal. About one baby born per hour is an addict.  Staggering.

A woman with stage 4 breast cancer chooses palliative care rather than treatment.  I decided a long time ago that, the next time I get really, really sick -- whatever it is -- I will not fight.  I've fought enough.  So I get this woman's decision.  She tells it well -- the doctor who outlined all the treatments, all the hell he'd put her through, just to buy a little more time.  A little more suffering time?  No thanks.  We all go, and if we're lucky, we have something to say about how and even when.  In the patient's calculus, quality of life may mean as much as living a few more months.  It's the patient's choice -- or it should be.

Two new studies find that woman over age 40 with risk factors (for example, a sibling or parent with breast cancer) should get mammograms every other year, attempting to quell the controversy over the frequency of mammograms.  The recommendation is personalized medicine, a decision based on the patient's history rather than a one-size-fits-all prescription. 

Here's one to watch for.  If you go to the hospital and stay for "observation" without being admitted, your insurance company won't pay as if you were inpatient.  This primarily is a Medicare issue, but don't be surprised to see commercial insurers following suit. 

Sleep may help you avoid the genetics of obesity.  If you're prone to being overweight but sleep a lot, you may be able to overcome your genes and avoid weight gain.  I think this is the best news I've ever heard!  Now, I have yet another reason to sleep!

The Connecticut Department of Social Services proposes a new payment model for people who are eligible for both Medicare and Medicaid due to illness and poverty.  Part of the plan would give extra payments to providers who save money -- an incentive to limit treatment.  The State simply rejects the clear logic of that argument.  This isn't looking good.

And that's it for this Tuesday Morning.  Have a great May Day!  Jennifer

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