Chiropractic Economics Blog

Dean Gary Raskob (University of Oklahoma) testified before the Senate Committee on Health, Education, Labor and Pensions (HELP) at a hearing entitled “Health Care Reform Legislative Options.” Dean Raskob began his testimony by noting “The culture of the health care system in the United States needs to be transformed from one that emphasizes treatment…to a different paradigm – in short, a culture of wellness.” In response to the current bill, Dean Raskob highlighted four over-arching elements that are key to creating a culture of wellness.

First, Dean Raskob acknowledged that the bill underscores the importance of the full spectrum of prevention, from community-based primary prevention to clinical preventive services. Second, the bill recognizes the importance of the community, the school and the workplace as critical locations for implementing prevention and wellness efforts. He expressed ASPH’s support of providing tax incentives to encourage employers to adopt workplace wellness and prevention programs that are evidence-based. Next, Dean Raskob highlighted the need for sustained and expanded public health research, especially in the areas of prevention and public health systems, including comparative effectiveness research. In closing, Dean Raskob emphasized the importance of addressing the broad public health workforce needs.

A full copy of the Dean Raskob’s testimony is available here. In addition to his testimony, Dean Raskob also submitted the ASPH Policy Brief titled “Creating a Culture of Wellness: Building Health Care Reform on Prevention and Public Health.”

The hearing included an extensive list of witnesses. Among those witnesses were Dr. Jeff Levi, executive director of Trust for America’s Health; Dr. Katherine Baicker, professor of health economics at the Harvard School of Public Health; Mr. Ron Williams, CEO of Aetna Inc.; Mr. Dennis Rivera, chair of Service Employees Internati onal Union; and Mr. Steve Burd, president and CEO of Safeway, Inc.

This comes from our friend Kent Greenawalt at Foot Levelers:

As you know, political action is based on money and power, and if we as chiropractors want to be considered for all the opportunities we hope for under the new administration, we must consolidate our message and develop methods of harnessing the massive impact of chiropractic patients voicing their support for inclusion and expansion of covered services in all national health care reform. The people clearly want it, but without a way to demonstrate the support, chiropractic may suffer the consequences.

One way to mobilize the political power of chiropractic is to compile an effective email list, with addresses of doctors and patients so any legislative efforts can be coordinated quickly and inexpensively. In order for this to work, doctors must be willing to collect email addresses of patients and concerned citizens and pool them to amplify the effect.

If each chiropractor provides 250 names, and we could get 4000 DCs to participate, that would be 1,000,000 emails letting the legislators know the viewpoint of chiropractors and their patients. Obviously, more addresses and more chiropractors would create an even greater outcome.

With the impending changes in national health care, it’s essential that chiropractors be willing to act on their patients’ behalf. Simply go to www.ChiroVoice.com or www.AdjustTheVote.com for information about how you and your patients can stand up and be counted for chiropractic. Patients can sign up directly on those websites, and will only be contacted for legislative reasons, with simple directions on how their voices as concerned chiropractic patients can be heard.

If you want to recruit patients to participate, here’s a simple idea for encouraging them to declare themselves as chiropractic supporters. After the visit, say something like this:

“(Patient’s name), one more thing before you go — our national associations are compiling a list of citizens who want to have their voices heard in regard to national health care. President Obama wants to make changes and we all know what happens when we don’t get involved. If you want to be sure that chiropractic patients are included and your rights protected, please give me your name, address and e-mail and my staff will take care of it for you. About once a month you may receive an update on what is going on with health care.  If there is a time when you will need to get in touch with your legislator, you will receive an e-mail with a link to his or her website. Then you can send a personal message to request he or she votes to support your access to appropriate chiropractic care. We must send our message to Congress. This is really important for all chiropractic patients, so thanks for your help.”

Please step up for our beloved profession, and for the people you serve – it costs nothing, but it will surely pay.

There is an interesting article in the Nutrition Business Journal about a Washington Post article, that shared some grumblings about the National Center for Complementary and Alternative Medicine.

A juicy quote from the Post article:

“With a new administration and President Obama’s stated goal of moving science to the forefront, now is the time for scientists to start speaking up about issues that concern us,” Steven Salzberg, a genome researcher and computational biologist at the University of Maryland, said last week. “One of our concerns is that the NIH is funding pseudoscience.”

Recent research projects on chiropractic care supported by the National Center for Complementary and Alternative Medicine (NCCAM) have focused on the:

• Effectiveness of chiropractic treatments for back pain, neck pain, and headache, as well as for other health conditions such as temporomandibular disorders
• Development of a curriculum to increase the number of chiropractors involved in research
  Influence of people’s satisfaction with chiropractic care on their response to treatment.

Original article

David Blumenthal has been named National Coordinator for Health Information Technology.

The Boston physician is an M.D., M.P.P. and is now the lead dog in implementing the nationwide interoperable, privacy-protected health information technology infrastructure as called for in the American Recovery and Reinvestment Act.

The guy is certainly qualified as the former director of the Institute for Health Policy at The Massachusetts General Hospital/Partners HealthCare System in Boston, Mass. He was also Professor of Medicine and Professor of Health Care Policy at Harvard Medical School so he might be smart.

There, he also served as director of the Harvard University Interfaculty Program for Health Systems Improvement. Prior to that, he was senior vice president at Boston’s Brigham and Women’s Hospital and served as executive director of the Center for Health Policy and Management and as a lecturer on Public Policy at the John F. Kennedy School of Government.

“As a primary care physician who has used an electronic record to care for patients every day for 10 years, I understand the enormous potential of this technology,” Blumenthal said. President Obama has laid out a vision of health reform that is both inspiring and long overdue. We cannot make that vision a reality without the help of our most advanced computer technology.”

He doesn’t have any chiropractic background but seems to have a good grasp on electronic records and public health policy.

Walmart’s going to start selling a package including Dell computers and eClinicalworks software through it’s Sam’s Club stores. You know, the giant warehouses where you can buy flat screens and 5 lb. buckets of peanut butter.

It will almost certainly be cheaper than the alternative, but will DCs and other medical professionals want to use Sam’s Club as a healthcare partner?

Some already do, according to Sam’s Club spokeswoman Susan Koehler.

“This will be an extension service of what we do already,” she said. “We have more than 200,000 medical practices that we are already serving.”

She’s mostly talking about the optometry and drug store setups they have, however the HealthIT plan goes a little deeper.

“We will be a single point of contact to help with training, installation, maintenance,” Koehler said.

So, the big question is whether the (probable) cheaper cost will offset the negative view (am I wrong here?) of having your health IT services run by the crew at Walmart?

Let me know what you think.

You cynics can chalk it up to shameless self-promotion, but I think many of you will find this useful.

I just posted this article from our wonderful new freelancer, Julie Duck. It’s explains some of the deadlines and incentives for EHR implementation that exists in the stimulus bill.

Why you need an EHR solution now more than ever

The administration has launched www.healthreform.gov to “allow Americans to view today’s White House Health Forum, share their thoughts about health reform with the Obama Administration and sign a statement in support of President Obama’s commitment to enacting comprehensive health reform this year.”

From what I can tell it is similar to www.recovery.gov with a little less detail. Probably due to the fact it hasn’t been up very long.

The new web site launch coincides with a report from Health and Human Services “Americans Speak on Health Reform.” This report is a summary of Healthcare Community Discussions that President Obama asked citizens to hold in Dec.  The report is available on the web page.

A few points:

• The cost of health care services and health insurance was the top concern about the health care system for 55 percent of discussion participants.
• Participants also cited lack of emphasis on prevention, pre-existing conditions limiting insurance access, and the quality of care as key concerns. (Prevention, right? So that makes DCs a hundred years or so ahead of the game.)

• Discussions focused on concerns about a “broken” health system, access to health insurance and services, rising premiums and drug costs, medical mistakes and the system not being “for them.” (They got the “not for them” thing right on the money)

One other cool thing on this site is your ability to stream the White House Forum on Healthcare. It started about an hour ago but is sceduled to go till after 4. After Obama’s intitial speach they had breakout sessions in 5 different rooms and you can stream all of them depending on your interest.

It’s kind of crazy if you think about it. 5 years ago if you didn’t set your VCR to C-SPAN you’d never hear about it.

I received a really smart analysis of Obama’s proposed healthcare reform budget. It’s not chiropractic specific, but if somewhere down the line healthcare overtakes stabilizing the economy as #1 on the agenda, the system you work in now will have little in common with what you’re working with in 2020.

No credit to give as I was asked to keep it anonymous. (Sneaky, right?)

Obama’s budget calls for:

• Creating a $634 billion reserve fund over the next 10 years to finance a universal access proposal that will most likely cost at least $1 trillion. (ED NOTE: Sounds like a giant number, but as healthcare spending in America has hovered about $3 trillion for the last few years, I’d venture to say 1 trillion over 10 years is not as crazy as it seems initially.)

 This fund would be filled from 2 major sources:
• $318 billion in new revenues from tax increases on families earning more than $250,000, and the remainder from cost-saving measures.
• The biggest part of the proposed cost savings would come from cut payments to Medicare Advantage plans, estimated around $177 billion, under a new competitive bidding process. (ED NOTE: Similar to the defense contracts bidding changes announced today)
• That leaves $139 billion in cost savings from a battery of smaller sources, some of which are well-defined and others we’re completely in the dark about.

These smaller sources include (dollars measured over a 10-year period):
• $37.1 billion from “improved Medicare home health payments”—the savings assumption here is not very clear, but maybe reflects acute care and nursing home care savings from better access to home health care
• $19.6 billion from higher drug company discounts—from 15% to 21%—on medications provided to Medicaid patients
• $17.8 billion from bundling Medicare payments to cover both the hospitalization and 30 days post-discharge (may see slightly longer ALOS to avoid readmission - mainly medical patients)
• $12.1 billion from Medicare hospital pay-for-performance
• $8.4 billion in penalties for hospitals that have high readmission rates (may see overall admissions decrease as hospitals try to avoid penalties)
• $8.1 billion by charging high-income Medicare beneficiaries a higher premium for Part D drug coverage

(ED NOTE: Translation: This money may not come directly from DCs or your practice, but you’re lying to yourself if you don’t think you’ll be affected)

There are a lot of items that are not on the list, but will have to be eventually, if President Obama is to reach his goal of universal coverage.  The President’s budget director, Peter Orszag, is aware of this.
As director of the Congressional Budget Office, in December he published a 221-page tome that quantified the value of 115 possible reform measures—basically pre-scoring the options available to legislators.
The document made clear where the money is in health care reform—which elements matter and which ones, from a budget perspective, do not.  This leaves little room for budgetary sleight-of-hand on either end of Pennsylvania Avenue as the reform debate progresses.

These unmentioned items that will be essential if universal coverage is to be achieved include:

• Slower growth in payments to hospitals and physicians—This could take a variety of forms, from simply lowering the percentage of fee increases to “flattening” out spending disparities across the country.  An article published in the New England Journal of Medicine today shows new data from the Dartmouth Atlas, documenting how regional variation continues to grow.  The authors estimate that reducing the rate of increase in Medicare spending from 3.5% to 2.4% (from the national average to the average for low-cost area San Francisco) would save $1.4 trillion through 2023.

• Change in the tax treatment of health benefits—By capping the amount of premiums that employers can deduct from taxes, capping the exemption from individual income taxes of employer-provided health benefits, or some combination thereof. 

• Obama needs Republican votes on healthcare reform.  Do not be surprised if, as a way to reach out to Republicans, he endorses some version of Sen. John McCain’s campaign tax proposal:  Eliminating the corporate tax deduction and individual income tax exemption for employer-provided health benefits, and replacing them with a flat individual tax deduction.  Though Democrats would howl at the idea, it could be smart politics and plug a big budget hole.  Peter Orszag’s own math shows that this change would be worth in the neighborhood of half a trillion dollars over ten years.

The President focused his budget outline on financing.  He leaves to the legislative process the details of how to achieve universal access, minimum benefit plans, use of public vs. private options, etc.  This strategy reflects learning from the failed Clinton reform proposal of 15 years ago, which was encyclopedic in detail and developed mostly behind closed doors.

What will health organizations do?  Watch, wait and pump up their lobbying budgets.  If a sweeping health care reform measure does pass in the coming year or 2—and that is far from certain—it brings with it the potential to largely erase healthcare providers’ concerns about no-pay patients, but at a great cost in other ways.

ED NOTE:

And thats it. Good? Bad? Think it’s the end of the world as you know it? Let us know.

I got an email from a non-profit called Economic Turning Point. Their main idea is to use the instant communication ability of the internet to bypass some of the hardships of previous downturns when info wasn’t .

Topics include everything from debt restructuring, monetizing the national debt, increasing taxes, decreasing taxes, increasing spending, decreasing spending, nationalizing banks, nationalizing industry, returning to a ‘gold standard’, etc.

You can read other peoples posts without signing up, but if you want to prove you’ve got the solution to the madness you have to sign up. (its Free)

Have fun!

www.economicturningpoint.com

I got passed this in an e-mail from Alex Niswander. It was basically an ad for his company but one part of it did a good job of breaking down some applicable details. Most of it is geared to make sure you are eligible for the stimulus grants that are coming sometime in the not so distant future.

Stimulus Package Overview

Disclaimer: At this time, details are very generic and open to further ruling by the commissioner in charge of project (who is not yet hired at this time). This information is our interpretation of the information available at this time.

 
General Information:

* There are two programs for EMR reimbursement: Medicare and Medicaid.
* Both programs include Chiropractic specialty.
* Funds become available on Jan 1, 2011, although must be already utilizing an EMR.
 
Medicare Program Details:

* Provider must bill over $24,000 in medicare claims during the year in order to reach full reimbursement potentials.
* Up to 44K in reimbursement is possible over a 5 year time for using an ‘electronic medical records’ system.
* Must be fully electronic by 2015 in order to avoid penalties such as reduced payment percentages on claims.
* Early adaptation of EMR beginning in 2011 receive a $3,000 bonus in year one.
* Must demonstrate meaningful use of EMR.
 
Medicaid Program Details:

* As a Medicaid Provider you see more than 30% Medicaid patients.
* Provider would receive 85% of EMR (electronic medical record) costs (not exceeding $25,000) in the first year.
* Provider would receive 85% of the annual maintenance costs (not exceeding $10,000).
* Must demonstrate meaningful use of EMR.

Alex’s company can be found at www.quick-charts.com