Do it yourself death panel

How are you feelin' today, mom?

How you feelin’ today, mom?

Federal law allows states to recover Medicaid costs from heirs. This little known provision is getting more attention as part of the debate over Medicaid expansion. The Wall Street Journal (New Wrinkle for Health Law) wrote a balanced article about it, highlighting consumer fears about having to sell assets while also sharing the government perspective that “estate recovery helps shore up the program for others who need it.”

The online comments and letter to the editor generally support the view that recipients’ estates should have to pay back the government. The letter (First, Estates Should Repay the Taxpayersis characteristic of the righteous indignation provided by the commenters.

Where is it written that a person is entitled at death to leave assets to children, particularly after someone else, in this case the taxpayers who fund Medicaid, has paid the health-care bills? Where is it written that children are entitled to inherit assets from a parent who has unpaid bills for services received during his or her lifetime?

Maybe if the issue were framed differently the commenters would rethink. Two points in particular:

  • If we seek to reclaim Medicaid payments we need to reclaim Medicare payments as well. Although recipients pay into the system, Medicare is far from self-sustaining. More than 40 percent of Medicare spending is financed from general revenues.
  • If the government starts going after estates for medical expenses more broadly, dying patients will worry that heirs will ration care to preserve their own inheritances. And with so much at stake, it’s not a paranoid thought

So here’s my question for the commenters and letter writers: Are you willing to expand this logic to Medicare and provide your own heirs with an incentive to form a death panel for you?

Image courtesy of artur84 at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

 

Meaningless Use: Pediatric portal example

I love my family’s pediatrician. He’s an old school guy who keeps up with the literature, is a great diagnostician, has an informative and comforting manner, and uses the hospital system’s medical records and phone calls to track the progress of his sicker patients as they deal with specialists. He’s available for a call-in hour every morning.

The practice’s patient portal from eClinicalWorks is another matter. The “PHR-View” has tabs for Allergies, Vitals and Immunizations. The information appears to be complete, which is nice, but where is the standard form that I need for school, camp, etc? It’s nowhere to be found and I have confirmed with the practice that it isn’t available. The practice doesn’t like to use the secure message system, which anyway doesn’t allow attachments.

Bottom line? I obtain the forms the same way I did close to 20 years ago: Call the practice and ask them to fax the form. They are always happy to do it, but it seems a little silly. Surely we can expect more from patient and family portals in 2015.

By healthcare business consultant David E. Williams, president of Health Business Group.

Popular in Pittsburgh

Pittsburgh, PA

Pittsburgh, PA

I’m quoted in two recent articles in the Pittsburgh Tribune-Review:

By healthcare business consultant David E. Williams, president of Health Business Group.

Financial services shows the way for healthcare (again)

Seven hundred million people worldwide have obtained access to financial services for the first time over the past three years, according to a Gates Foundation funded institute. The big increase is due largely to the banking industry figuring out how to leverage low cost mobile phones and digital payments to improve accessibility of the previously “unbanked.” I’d like to see healthcare do something similar.

The USA Today points out some of the benefits consumers reap when they gain access:

“Financial inclusion, such as the ability to save money, access credit and keep money secure, is considered critical for reducing poverty and increasing economic growth. World Bank Group President Jim Yong Kim called access to financial services ‘a bridge out of poverty.’

Visa is working with small merchants in developing countries to equip them with point-of-sale terminals that operate over mobile phones so they can process digital financial transactions, an endeavor that has good social impact but also makes business sense for Visa…”

Financial services was (and remains) way ahead of healthcare in applying technology and digital solutions to democratize the marketplace. Online customer portals at Vanguard and Fidelity are way ahead of what consumers can get from their hospitals and health systems.

I hope healthcare won’t take as long to take advantage of newer opportunities such as the spread of cellphones, the Internet, and the financial services industry itself. In the developing world the formerly “unbanked” and currently “untreated” could leverage technology for clinical decision support, remote monitoring, electronic prescribing and adherence, not to mention population health reporting and management.

By healthcare business consultant David E. Williams, president of Health Business Group.

E-cigarettes: the California Cooler of the 21st century

Just a harmless, tasty treat?

Just a harmless, tasty treat?

If like me you came of age in the 1980s you remember the California Cooler, a sweet wine/juice combo that made it easy for kids to start drinking alcohol even if they couldn’t handle the “adult” taste of beer, wine or liquor. They were very popular at the time but I don’t recall anyone ever saying they were a healthy alternative to anything.

Fast forward 30 years to the e-cigarette era. New data show 13 percent of high school students use e-cigarettes. From the Boston Globe (E-cigarette use spikes among American teens)

In interviews, teenagers said that e-cigarettes had become almost as common at school as laptops, a change from several years ago, when few had seen the gadgets… A significant share said they were using the devices to quit smoking cigarettes or marijuana, while others said they had never smoked but liked being part of the trend and enjoyed the taste — two favorite flavors were Sweet Tart and Unicorn Puke, which one student described as “every flavor Skittle compressed into one.”

Policymakers are confused. E-cigarettes seem safer than smoking, and at least some people must be using them to try to quit. But my view is that at least for kids they lower the barriers to unhealthy behaviors by making drug use more like having a candy or soft drink. The FDA banned nicotine lollipops. Why is this different?

I’m concerned about this delivery method for nicotine, but I’m also worried about marijuana. E-cig entrepreneurs have been busy finding ways to use the devices to deliver THC, and there is a big rise in marijuana laced foods, so-called edibles or medibles. Let’s not fool ourselves and our kids by pretending these drugs are harmless treats.

Image courtesy of patrisyu at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

Care transitions: Interview with Curaspan CEO Tom Ferry

Tom Ferry, Curaspan co-founder and CEO

Tom Ferry, Curaspan co-founder and CEO

When Tom Ferry co-founded Curaspan back in 1999, discharge planning wasn’t the sexiest arena for a Harvard MBA to jump into. But he was on to something because 15 years later “transitions of care” is a mainstream term, there is a major focus on readmissions prevention, and post-acute care is universally recognized as the greatest opportunity for cost savings. Curaspan is right in the thick of it.

Though we both live in Boston, I met up with Tom at the #HIMSS15 conference in Chicago. Curaspan is exhibiting at HIMSS for the first time, and its booth is seeing a steady stream of traffic. In this podcast interview, Tom discusses the importance of care transitions and how Curaspan plays a role in addressing the challenges.

  1. Why are transitions of care important? (0:08)
  2. How does the hospital discharge process typically work? How should it work? (0:42)
  3. There is tremendous variation in cost and quality in post acute care. Why? (1:23)
  4. What role are new payment arrangements such as ACOs and bundled payments having on the discharge process? (1:53)
  5. Hospitals are typically paid on a DRG basis for what happens in the hospital. If we move to an episode based system what will happen to post-acute providers such as skilled nursing facilities? (2:41)
  6. Do you plan to incorporate data and analytics to determine where a patient should go based on their individual characteristics? (3:42)
  7. How do patient and family engagement play into the discharge process? (5:16)
  8. Why did you start Curaspan? How has the concept evolved since then? (6:25)
  9. What products and services do you offer on the Curaspan platform? (7:23)
  10. What are your objectives for the HIMSS conference? (8:42)

By healthcare business consultant David E. Williams, president of Health Business Group.