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The one where I get all soapboxy about the term Obamacare

Tidal Basin

Dear Friends, Pundits, and Politicians,

Can we please stop calling health reform Obamacare?

Opponents began calling the health reform law and its associated components Obamacare as a way to both detract from the law and the President. Those who are not in favor of the PPACA report on Obamacare’s problems and challenges; linking the bill and the President hand in hand with some scary story about how Americans will somehow be less well off if more people have access to healthcare. Let’s defund Obamacare sounds a little to me like taking your toys and going home.

[And, correct me if I’m wrong, I don’t remember calling anything the Bushwar, Clintonbudget or Kennedymoonmission - when did taking liberties with the President’s name become acceptable?]

Those in favor of the the PPACA have co-opted the term; adopting in as a rally cry for the Act’s benefits. Do you like Obamacare, I think it’s a good thing… people will confide in me during meetings and events. Even CMS and policy wonks promoting the Act use the term frequently. Remember the kid in school with an unkind nickname who eventually started referring him-or-herself by the nickname? I bet they didn’t love it, deep down inside.

But here’s the thing…

We’re talking about healthcare. We’re talking about the difference between someone being able to see a doctor or not, to get medications or not, to have better, more fulfilling lives… or not. Making healthcare about politics —and I understand, the two have been an odd couple well before Jack Lemmon and Walter Matthau —does our humanity a disservice.

It’s not Obamacare, it’s the PPACA, health reform, Medicaid expansion, health insurance exchanges, accountable and population health, wellness visits and more.

And besides, spellcheck doesn’t even think Obamacare is a word.

Now, would someone help me down from this soap box, my knees aren’t what they used to be.

From elsewhere: NC hospital closes, but was it really because of politics?

You know you are early for your flight when...

Posting on the Huffington Post, Jeffery Young writes: North Carolina Hospital Closes, Citing No Medicaid Expansion

A small hospital in a coastal North Carolina community will close its doors within months and its parent company says Gov. Pat McCrory’s (R) decision not to expand Medicaid under President Barack Obama’s health care reform law is partly to blame.

But wait, there’s more…

Other considerations, including outdated facilities, also led to the company’s decision to close the hospital but North Carolina foregoing the Medicaid expansion contributed to the decision, Vidant Health CEO David Herman told The Huffington Post.

I’m not surprised we’re seeing smaller community hospitals struggle. Last week the great Mike Sevilla, MD wrote an op-ed for KevinMD questioning: is the end near for small community hospitals?

Without doubt, I think we’ll see more of these closures. But we have to also pay attention to the root cause, particularly in these still early days of PPACA’s implementation.

Note Mr. Herman’s other considerations —outdated facilities. At some point, buying a multimillion dollar scanner or other required life saving equipment for a 49 bed hospital just doesn’t make sense.

It also may not make sense to operate 49 bed hospitals within an hour’s drive of a larger, more sophisticated facility.

We’re seeing the shift away from the shiny hospital on the hill as the only anchor for providers and care delivery for a community.

That story is a lot more interesting than politics and Medicaid expansion.

Articles on hospital charges raise eyebrows, but they miss the mark —charges mean very little

There’s been a lot of talk this week about the data CMS released. It shows hospital charges and Medicare payment.

Articles like this raise eyebrows:

In one hospital in Dallas, the average bill for treating simple pneumonia was $14,610, while another there charged over $38,000.

via Hospital Billing Varies Wildly, U.S. Data Shows -

And they are missing the big picture.

The reason prices vary so greatly is the result of how commercial insurance contracts are negotiated and paid.

Hospitals want an annual margin - about 4% on average. To get there, they have to look at what the contracts pay well on and what they don’t. Medicare is irrelevant because it pays on a fee schedule. So they focus on commercial contracts. If one hospital’s contracts pay well on pneumonia, then the price gets raised.

I’m not assigning a value judgement to how or why this is done. But it is worth pointing out.

I also think it’s misleading to suggest those without insurance foot the full bill. While there are tragic examples, that’s rarely the case. Again, not suggesting its right or wrong, just saying there’s more to the story.

What can we learn from hospital charges? Very little. They are the ghosts of an ever changing industry based on a third party payment system.

NPR plays it safer:

…the numbers only tell us part of the story. “Charges are list prices,” he says. “They’re sticker prices.”

The Washington Post addressess uninsured programs:

“The chargemaster can be confusing because it’s highly variable and generally not what a consumer would pay,” said Carol Steinberg, vice president at the American Hospital Association. “Even an uninsured person isn’t always paying the chargemaster rate.”

Paul Levy nails it on his blog, (although he and I may disagree on the role of commercial insurance):

This is a case where the release of bad data is worse than having no data at all. A hospital’s chargemaster is an archaic fiction, a way previously used to allocate the joint and common costs of the hospital to particular services. It does not serve as the basis for how much a hospital is paid by Medicare. It does not serve as the basis for how much a hospital is paid by Medicaid. It does not serve as the basis for how much a hospital is paid by private insurers.

Updated to add:

David Lazarus asks if we are ok with the end result - high bills, in the his LA Times coverage:

Medical costs are often inexplicably high and are almost always kept hidden from patients until the bill arrives. Health insurance, meanwhile, is frequently coverage in name only.

What do you think? Does the charge data tell you anything meaningful?

From Elsewhere: Medicare Discloses Hospitals' Bonuses, Penalties Based On Quality and man does it tell a story

Last week, CMS, the Centers for Medicare and Medicaid Services, announced the names of hospitals who received bonuses for quality. It also listed the names of hospitals which received penalties. Kaiser Health News has done a great job of covering the story.

Here’s what I find to be the single, most telling thing:

Nicholas Genna, CEO of Treasure Valley Hospital in Idaho, recipient of the biggest bonus, credited close attention to patients, including a low nurse-to-patient ratio and handwritten thank-you notes to patients, along with the fact that the doctors own the hospital. “People answer the phone with a smile on their face,” he said.

If that doesn’t validate…nay…quantify the importance of making patient experience the top priority, I don’t know what does.

Compare Mr. Genna’s comments to those from the most penalized hospital:

Thomas Filiak, the chief operating officer at Auburn Community Hospital in New York, which received the largest penalty, said executives have begun a number of initiatives to lower noise near patient hallways, including putting new wheels on squeaky food carts. “They sounded like Mack trucks going through the hallway,” he said.

One speaks to actions and the other to lip service. Sure, squeaky carts are annoying and may lead to a less than favorable result on one particular HCAHPS question. But ask yourself this, for which of these places would you rather work? At which would you rather seek care?

Don’t get me wrong, I’m applauding Mr. Filiak’s efforts and I’m sure the leadership team at Auburn Community is well poised for a fantastic turnaround — I’m looking forward to reading that story in 2013.

What I’m suggesting is that Treasure Valley’s success is clearly the result of a patient-centered culture, and it shows in how patients feel about them and in turn how Medicare is rewarding those kinds of culture.

via Medicare Discloses Hospitals' Bonuses, Penalties Based On Quality - Kaiser Health News.

Elsewhere: "I fear to be a patient" by Don Berwick

For my elsewhere series, I like to highlight content from others from around the web. Usually, I preface those blurbs and links. Sometimes something is so powerful it can and should stand on its own. Don Berwick is a pediatrician and the current Administrator for the Center of Medicare Services (CMS) by appointment of President Obama.