Morning Read: A controversial new type of health insurance in Oregon

Highlights of the important and the interesting from the world of health care:

A controversial new type of health insurance in Oregon: Five Oregon health insurers are set to begin selling a new type of “carrot-and-stick” insurance plan that’s aimed at pushing employees towards more proven treatments and away from tests and surgeries that are deemed less valuable, Kaiser Health News reports. For example, these so-called “value-based plans” would offer free care for some illnesses, such as diabetes or depression, but require hefty extra fees for treatments deemed overused, including knee replacements, hysterectomies and heart bypass surgery. Opponents say the plans will likely limit patients’ access to care. So far there’s just one taker among the state’s employers–Evraz Oregon Steel, even though the company is offering the plans without monthly premiums. Still, a company administrator expects only 30 of 450 employees to sign up.

The plans are designed to challenge the long-held American notion that “more care is better care,” proponents say. Like typical insurance plans, these have employee deductibles and co-pays, but they offer free or very inexpensive care and prescription drugs for common conditions. But if patients seek knee or hip replacements, cardiac bypass surgery, artery-opening stents, hysterectomies, or high-tech-imaging exams, they’ll be hit with big bills. It seems the difficult thing with these plans will be determining exactly what sort of unproven treatments to include in the high-cost bucket, as a critic below notes. But you can bet if these plans help employers lower health costs, one of them will be coming to a benefits meeting near you.

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Applying the same high fees to everyone is “too much of a blunt instrument,” according to one critic, who says the Oregon policies need to be more nuanced and provide exemptions. “There are relatively few procedures where you can say for everyone that ’this is a low value.’”

Congress’ skin in the game: Jon Cohn points out an often-overlooked but symbolically important part of the Senate health reform bill that requires members of Congress and their staffers to get health insurance via the “exchanges” the bill would create. These exchanges are designed for people without jobs or at very small employers that don’t offer insurance. The exchanges would be a marketplace that such people would use to shop for health insurance policies offered by a number of competing health insurers, allowing consumers to pool their purchasing power and (hopefully) get cheaper rates than they otherwise would have. One key fact Cohn points out is that exchanges were a Republican idea (at least in terms of drawing up this particular bill) from Iowa Sen. Charles Grassley. The exchanges’ Congressional requirements are not only great policy, but great politics–a very rare match in Washington, D.C. Credit Grassley for sparking the idea and Democrats for being open to it.

Social media ‘risky business’ for health providers: Notable blogger and primary care doctor KevinMD has gone on record as saying that doctors risk sliding into irrelevance if they don’t embrace social media. Facebook, Twitter and the like provide a doctor with a means of extending the conversation with patients beyond the typical 15-minute office visit, he reasons. But social media holds plenty of pratfalls for providers, too, according to an article (pdf) in Health Lawyers. For example, doctors are at constant risk of violating HIPAA, a patient-privacy-protection law, by divulging too much information in a Tweet. And it’s possible that a doctor who intends to innocuously advise a patient via Twitter is setting himself for a malpractice claim–in contrast to say a friendly chat with a neighbor–given the electronic archiving of social media.

But those possibilities, albeit remote, shouldn’t stop many doctors from connecting with patients online. Case in point, the CEO at Beth Israel Deaconess Medical Center in Boston says banning social media would do more harm to medical professionals than good. Instead, employers should emphasize what employees can do with social media, such as being transparent and authentic at all times and avoiding betrayal of a patient’s or colleague’s trust, he says.

Med schools fail at patient safety: Medical schools may do a fine job of preparing young doctors to succeed from a clinical standpoint, but when it comes to imparting basic skills related to patient safety, they fall short. That’s the conclusion of a report from the way-too-long-of-a-name National Patient Safety Foundation’s Lucian Leape Institute, Modern Healthcare reports. Here’s the article’s money quote, which paraphrases Mr. Leape himself, a Harvard Medical School professor: ’’Too often, the students are being educated in a toxic environment’ where some 5 percent of physicians who mistreat residents, students and nurses are allowed to ‘poison the well’ with a shame-and-blame culture that perpetuates medical errors.” Sounds like a bad episode of Scrubs (but weren’t they all?) Nonetheless, Leape’s words should motivate top officials at medical schools to identify that 5 percent and get them and their “poison” away from tomorrow’s generation of doctors.

Photo from flickr user Meng Bomin