By George W. Chapman
New York state has issued a directive prohibiting any insurer, including Medicaid, from charging a member for any out-of-pocket costs related to testing for the virus or any related visits to a physician’s office or emergency department. Gov. Cuomo has also approved a $40 million emergency response package. Self-insured plans are not regulated by NYS, but they would be wise to follow suit. Most commercial carriers have indicated they will follow suit and not charge their members. The federal government has budgeted $8.3 billion to combat the virus. (As of this writing in mid-March there is a huge shortage of testing kits.) Federal spending goes toward: removing restrictions for treatment via telemedicine; reimbursing states for the virus response and preparedness; buying drugs, masks and personal protection for healthcare workers; and funds for caregivers and communities facing the brunt of the virus.
Amazon’s Huge Influence
Just as Amazon changed the way we shop, resulting in the closure of 9,000 brick-and-mortar stores last year alone, so it is changing the way we receive medical care. It is opening primary care clinics, virtual medical services and an online pharmacy called PillPack. Amazon is working on an Alexa-based program whereby consumers can query drug interactions and side effects as well as manage their meds. Information will be updated regularly. The company is also working on clinical speech recognition whereby provider-patient conversations will automatically be documented in the medical record. This will have a significant impact on “he said, she said” conversations. Amazon has the wherewithal, size, money, supply chain, artificial intelligence and IT expertise to alter the entire healthcare delivery system. Industry observers believe Amazon will have the same impact on brick-and-mortar providers as it did on stores. In lieu of the dire predictions of a physician shortage, Amazon could considerably reduce the deficit with increased automation and artificial intelligence.
ACA in Limbo
The fate of the Affordable Care Act remains up in the air. It won’t be determined by the Supreme Court until mid-2021 or later. Consequently, the delay exacerbates and prolongs the uncertainty and anxiety for insurers, providers and enrolled consumers. The makeup of the Supreme Court has shifted since it last upheld the ACA over a challenge regarding premium subsidies for the indigent five years ago. Last year, a court of appeals ruled the individual mandate was unconstitutional, but did not conclude the entire law was unconstitutional. Mostly “blue” states are challenging the entire law and therefore sending the issue to the Supreme Court. Politics pervades all decision-making in Washington.
Hospitals establish minimum volume standards (experience) for every procedure performed before granting a surgeon specific operating privileges. The bigger the hospital and medical staff, the more likely higher volume standards will be required. According to the independent hospital safety watch group “Leapfrog,” the majority of 2,100 hospitals surveyed are performing high-risk procedures with inadequate volume standards. The AHA and CMS are looking into this. In the meantime, it is perfectly acceptable for a patient to ask a physician for her or his experience with a particular procedure.
Non-college-Educated Worker “Deaths of Despair” Up
A study conducted by Princeton economists Anne Case and Angus Deaton found that “deaths of despair” — caused by alcoholism, drug abuse, suicides, depression, obesity — are soaring among America’s non-college educated workers. Similar deaths among the college-educated workers have remained stable. The escalating death rate has occurred primarily over the past three decades. This phenomena is explained in their new book titled, “Deaths of Despair and the Future of Capitalism.” Similarly, advanced countries in Europe are not experiencing this awful trend. Authors Case and Deaton point out that middle-class incomes have stagnated more in the US than other industrialized countries. Exacerbating the problem is our expensive healthcare system which impacts lower paid workers more by draining resources that could be spent on other things which would improve their lives. The “deaths of despair” among the non-college educated workers are up across all ages and races. The study found a growing number of these workers are finding it increasingly difficult to socialize or exercise because of chronic physical or mental conditions. The study found that most non-college educated Americans have decreased feelings of identity or pride with their employer. The authors believe the solutions are obvious, but will be difficult. Our medical system needs to put a higher priority on the health versus wealth of our citizens. Students who graduate from college, including technical schools, make more money and do better in life overall.
George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at firstname.lastname@example.org.