New England Journal of Medicine
http://www.wsj.com/articles/i-was-wrong-about-obamacare-1469997311 Large health systems deliver “personalized” care in the same way that GM can sell you a car with the desired options. Yet personal relationships of the kind often found in smaller practices are the key to the practice of medicine. They are the relationships that doctors want to forge with patients, and vice versa. It may sound old-fashioned, but what I have learned is that we do not need to sacrifice this unique feature of our health-care system as we move forward in adapting new value-based payment models and improving the health of patients.
WSJ By ANNA WILDE MATHEWS Updated Sept. 14, 2016 12:30 p.m. ET 199 COMMENTS The average cost of health coverage offered by employers pushed above $18,000 for a family plan this year, though the growth was slowed by the accelerating shift into high-deductible plans, according to a major survey. Annual premium cost rose 3% to $18,142 for an employer family plan in 2016, from $17,545 last year, according to the annual poll of employers performed by the nonprofit Kaiser Family Foundation along with the Health Research & Educational Trust, a nonprofit affiliated with the American Hospital Association. Employees paid 30% of the premiums for a family plan in 2016, compared with 29% last year, according to Kaiser. For an individual worker, the average annual cost of employer coverage was $6,435 in this year’s survey, with employees paying 18% of that total. The change in annual premium for individual coverage from 2015 wasn’t statistically significant. Economists have long debated the reasons for the slow pace of growth in premiums, which has continued for several years. Some have argued that the limited rate of increase is primarily linked to aftereffects of the recession and continued economic uncertainty. But the newest Kaiser survey highlights the effects of another shift: the continuing growth of plans that involve higher out-of-pocket costs in the form of deductibles. Kai
What Doctors Know About How Bad It Is, and Won’t Say Until a severe stroke sent him to a neurological intensive care unit in December 2014, Ernest Kohn was a particularly vibrant 90-year-old, still teaching a graduate economics class at Queens College. So his family thought he might rebound. But when his son, Jerry, asked the rotating flotilla of neurologists what was likely to happen — would his father survive? go home? — no one really wanted to address his questions. “When you pushed them, they said, ‘We can’t say anything with surety,’” Mr. Kohn said. “I kept saying, ‘I’m only asking for your opinion, not a guarantee. I’d really like to know what your 30 years of medical knowledge and experience tell you.’ Most of them would just clam up.” We’ve known for years that doctors hesitate or even decline to discuss a poor prognosis with patients and their families. They fear that bad news will dash hopes; they don’t want to appear to be giving up. Often, their training hasn’t prepared them for sensitive conversations
Bloomberg News (6/27, Ramkumar, 2.07M) reports that “during the study period, deductibles grew 86 percent and coinsurance costs rose 33 percent.” Although “co-payment costs fell…so did the number of insurance plans that charged them.” The data indicated “out-of-pocket costs exceeded the annual growth of insurance premiums…which increased 5.1 percent” annually.
John C. Goodman , CONTRIBUTOR I offer market-based healthcare solutions. Have you ever wondered why you doctor doesn’t talk to you by phone? Lawyers, accountants, engineers and just about every other professional you can think of discovered that phones are a handy way of communicating with clients almost a century ago. More recently, they turned to email. Why haven’t doctors made these discoveries? It gets worse. Have you ever wondered why the doctors who prescribe medications have no idea what they cost or where you can get the best price in the area where you live? All these questions have the same answer: doctors don’t get paid to do these things. Doctors are the only professionals in our society who are not free to re-package and re-price the services they offer to the market – when technology changes or demand changes or the state of knowledge of the profession changes. It starts with Medicare, which has a list of about 7,500 tasks that it pays physicians to perform. One problem with paying any professional according to a list of tasks is that there will always be things you don’t think of and leave off the list. For all practical purposes, Medicare left the telephone off the list. It also over looked emailing. Ditto for advising patients on being wise purchasers of drugs. The way Medicare pays is also the way Blue Cross pays. And Employers. And other insurers. T