Highlights of the important and the interesting from the world of health care:
A point of agreement for both sides in the health debate: It’s not exactly enough to get constantly bickering Congressional leaders to hold hands and sing glorious hymns, but there’s at least one point they can agree on: Rescissions by insurance companies are bad news. The practice of rescission, in which an insurance company cancels a person’s coverage after they’ve run up heavy bills, sounds vile to the public and is technically illegal. Yet it still happens, partly due to conflicting rules set up by states, according to Karen Politz, a Georgetown University professor by way of NPR. “We don’t have very good data about how often, but at congressional hearings last year, three insurers owned up to 20,000 cases in the last few years,” Politz says.
To be clear, the vast majority of Americans aren’t in danger of rescission. But those buy their insurance on the individual market or in a small-employee group are at risk. Rescission ties into the concept of pre-existing conditions, because insurance companies that employ the tactic typically do so along with the allegation that the insured person lied about a pre-exisiting condition on his application. Even the trade group that represents insurance companies says insurers should avoid the practice, though the group wants a ban on rescissions coupled with an individual mandate to buy insurance. Nonetheless, bipartisan sentiment against the practice is there, so some legislation banning rescission could be coming to Capitol Hill. And it may actually be something the Senate is capable of passing.
With the Rise of AI, What IP Disputes in Healthcare Are Likely to Emerge?
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
Anthera goes public: Anthera, a poster child for the disappointing biotech IPO market, won’t be getting off that poster any time soon. After last week delaying its initial public offering, it hit the market today–at half what it had previously hoped. The company opened at $7 after first targeting between $14 and $16. The market was decidedly underwhelmed as Anthera closed at $7.01. You have to wonder whether any other biotech with no sales and no drugs on the market will even contemplate an initial public offering this year. After Anthera’s experience, one hopes not.
Could Medicare cuts actually help doctors? Due to Jim Bunning’s obstructionism (and perhaps middle-finger flipping), the Senate didn’t pass a bill that would’ve stopped scheduled cuts in Medicare pay rates to doctors. That’s a bit of a surprise, since it seems every year this drama plays out with Congress stepping in at the last minute to avert the cuts. The American Medical Association is characteristically outraged, since this is a pet issue for the organization. The group’s leader, James Rohack, warns that the rate cuts will force physicians to turn away new Medicare patients. Writing at KevinMD, Dr. Floyd Reece agrees with Rohack, but says that’s ultimately not a bad thing for doctors.
Even if reform happens, Reece writes, the surge of newly insured patients will overwhelm the already stretched-thin medical system, which is already battling a shortage of primary care physicians. And that’ll put doctors in a much stronger negotiating position, according to Reece.
No matter what happens, government officials will have to explain to an angry public why people can no longer find a doctor to care for them in their communities, why no specialists are available in emergency rooms, and why people have to travel long distances to find a doctor.
A Personalized Approach to Medication Nonadherence
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
The mood of the electorate: That’d be “confused, conflicted, clueless and cranky” when it comes to health reform, according to pollster Humphrey Taylor, writing at The Health Care Blog. Perhaps that was always destined to be, given the complexity of the topic. Still, it’s striking that, as Taylor points out, 78 percent of the public thinks fundamental reforms are needed, but President Obama has been unable to galvanize much support for his plan, despite the widespread realization that the system is broken. If the polls seems to recommend a strategy of “Keep it simple, Stupid,” and if that’s impossible to do with such a complex topic, are we doomed forever to endlessly climbing premiums? And if so, will there be any sort of a middle class left in America in 30 years?
[Photo courtesy of flickr user AndyRob]
