Tag: Healthcare

It’s Now Boris’ England

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Yes, it is

It appears that the British National Health Service has decided to issue do not resuscitate orders for learning and developmentally disabled patients with Covid-19, because the UK was never properly de-Nazified at the end of the 2nd World War, I guess.

It’s something that I take kind of personally, since I have a nephew who, if he lived in the UK, would be subject to this sort of bigotry:

People with learning disabilities have been given do not resuscitate orders during the second wave of the pandemic, in spite of widespread condemnation of the practice last year and an urgent investigation by the care watchdog.

………

The Care Quality Commission said in December that inappropriate Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) notices had caused potentially avoidable deaths last year.

DNACPRs are usually made for people who are too frail to benefit from CPR, but Mencap said some seem to have been issued for people simply because they had a learning disability. The CQC is due to publish a report on the practice within weeks.

The disclosure comes as campaigners put growing pressure on ministers to reconsider a decision not to give people with learning disabilities priority for vaccinations. There is growing evidence that even those with a mild disability are more likely to die if they contract the coronavirus.

………

Younger people with learning disabilities aged 18 to 34 are 30 times more likely to die of Covid than others the same age, according to Public Health England.

Most people would call this horrifying, but I imagine that the Tories consider this an unintended benefit, because it reduces costs.

Tories Walk Back NHS Privatization

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And in the process, throw some serious shade at their former coalition members, the Liberal-Democrats.

We now have a report that 10 Downings Street is looking at rolling back changes made to the National Health Service in 2012 that promulgated privatization of the system.

This is not a surprise.  Increasing the role of the private sector in healthcare never produces better results.

What is interesting though is that the plan, which has been leaked, seems to have been couched in language pointing the finger at the Lib-Dems, probably because the Tories see them as more of a threat than Labour: (See other prominent mentions of the Lib-Dems here and here as well)

The Conservative Government is planning a major overhaul of the NHS by reversing some of the controversial privatisation plans introduced by the Tory-Lib Dem coalition, according to a leaked white paper.

The draft document suggested that Prime Minister Boris Johnson wants to reduce the role of the private sector in the NHS by reducing competition and competitive tendering and replacing it with collaboration between health providers.

………

The changes would effectively rollback some of the 2012 reforms of David Cameron’s Government with his Health Secretary Andrew Lansley that saw the establishment of NHS England to run the health service as well as the creation of GP-led clinical commissioning groups to organise local services.

The leaked proposals, published by Health Policy Insight, acknowledged the “unprecedented test to health and care services” caused by the COVID-19 pandemic, along with the “urgent” need for a “broader approach to health and care”.

………

It set out how England’s Health Secretary would assume “enhanced powers of direction” over a newly merged NHS England and NHS Improvement, to set direction in a more “agile” way.

Privatization has always been the worst possible approach to potential problems with a public health system, and it has always been unpopular.

The Covid-19 pandemic has made further movement in this direction untenable, and so the Tories are reversing course, and trying to leave their former coalition members holding the bag.

Breaking Things on the Way Out

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The Trump administration just authorized Tennessee to have its Medicaid funded through block grants.

Block grants is how Bill Clinton’s evil Welfare “Reform” worked, and the states took the money and spent it on things like romance lessions. 

The Trump administration wants to take a sledge hammer to Medicaid, and indirectly Obamacare, because they can.

So Nice that Pelosi Supported the Homophobic Campaign of Richard Neal

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Because after winning the primary, and the general, Ways and Means Chairman Neal is blocking surprise medical billing legislation, because he is owned by the hedge funds who have purchased medical practices, particularly emergency medicine practices, across the country to profit from massively overcharging people in emergency rooms:

A broad bipartisan effort to pass legislation protecting patients from massive “surprise” medical bills is now on life support as House Ways and Means Committee Chairman Richard Neal (D-Mass.) digs in on a separate proposal.

Democratic and Republican leaders of three committees in the House and Senate have been pushing for months to pass their measure, which would prevent Americans from unexpectedly getting hit with medical bills for thousands of dollars for common scenarios like treatment from a doctor outside their insurance network when they require emergency care.

Neal has been holding out for his own rival proposal and has not shown any willingness to budge despite concessions offered by top lawmakers on the three committees.

………

Supporters say they are extremely frustrated with Neal, given that lawmakers have been working on a bipartisan basis for two years to solve an issue many view as an especially egregious practice that should be low-hanging fruit for Congress. Lawmakers tried to pass the measure last December, but disagreements with Neal derailed the measure.

………

All sides agree that patients should be protected from getting massive medical bills through no fault of their own. But fierce divisions have emerged over how much the insurer would then pay the doctor or hospital once the patient is taken out of the middle.

The three committees — House Energy and Commerce, House Education and Labor and Senate Health, Education, Labor and Pensions — have in general favored an approach called benchmarking, which sets the payment rate based on the median amount that insurers in that area already pay in-network doctors. That approach is backed by insurers, unions and consumer groups who say it will save both consumers and the government more money than Neal’s proposal.

Hospitals and doctors, on the other hand, warn that would lead to damaging payment cuts. They favor an alternative process where an outside arbiter would decide the payment, through arbitration. That’s the approach proposed by Neal and Rep. Kevin Brady (Texas), the top Republican on the Ways and Means Committee, with Neal touting the support of hospital groups.

Backers of the three-committee approach say they offered a range of concessions to Neal, including one that only used Neal’s preferred method — arbitration — but he still did not agree.

………

The fierce lobbying from powerful doctor and hospital groups has caused further problems. Private equity firms that own doctor staffing companies previously funded millions of dollars in ads against the three-committee legislation.

Surprise billing became an issue in Neal’s primary race earlier this year; his progressive challenger, Alex Morse, [Against whom Neal and the Democratic Party establishment (There is no Democratic Party establishment) ran a viciously homophobic campaign] accused him of blocking surprise billing legislation because the private equity firm Blackstone is a major contributor to Neal. Neal ended up handily defeating Morse before going on to win reelection to Congress, where he has served since 1989.

Neal is now saying he wants to again delay the issue until next year, which backers of the three-committee approach take as a sign that he does not want to address the issue at all and is trying to delay it indefinitely.

Of course he is trying to delay it indefinitely.

He sees his job as to ensure that Blackstone and their Evil Minions™ get their vigorish so that he gets his campaign donations.

Can You Say ……… Dystopian? Good — I Knew You Could

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Google is looking at providing information services to employers to help them control their healthcare costs.

To put that into English, Google will collect enormous amounts of data about its clients employees in order flag people who are engaging in “Unhealthy Lifestyles” and mitigate employer exposure to healthcare costs.

Basically, they will spy on employees, and provide information that employers can use to meddle in their employees eat, when they sleep, etc.

And, though Google (Alphabet) will deny it, employers will use this data to fire employees who are flagged as healthcare cost risks.

If you want a picture of the Google’s future, imagine a boot stamping on a human face— forever:*

Without much fanfare, Verily, Alphabet’s life sciences unit, has launched Coefficient Insurance. It was only a matter of time before Google’s parent got into the health insurance business — in fact, one wonders what took it so long. With Google’s intimate knowledge of our daily patterns, contacts and dreams, the search engine group has for years had a far better picture of risk than any insurer.

That Coefficient Insurance, which is also backed by Swiss Re, would initially focus on the relatively arcane area of stop-loss insurance to protect employers from staff health cost volatility should not obscure its ambitious agenda for the rest of the industry. Thus, according to Verily’s senior management, it might soon start monitoring at-risk employees via their smartphones and even coaching them towards healthier lifestyles.

………

As with many services out of Silicon Valley, there is not much reflection about the probable reconfigurations of power among social groups — the sick and the healthy, the insured and the uninsured, the employers and the employees — that are likely to occur once the digital dust settles.

One would need to be extremely naive to believe that a more extensive digital surveillance system — in the workplace and, with Alphabet running the show, now also at home, in the car and wherever your smartphone takes you — is likely to benefit the weak and the destitute. Some good might come out of it — a healthier workplace, maybe — but we should also inquire who would bear the cost of this digital utopia.

………

Privacy law does not offer an adequate solution either. Under pressure from employers, most workers acquiesce to being monitored. This was obvious even before Alphabet’s foray into insurance, as plenty of smaller players have been pitching employers sophisticated workplace surveillance systems as a way of lowering healthcare costs.

If this does not scare the hell out of you, you have not been paying attention.

*Apologies to George Orwell.

Thanks, Andy

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Cuomo’s sellout to negligent nursing homes was so egregious that Republicans copied and pasted it into their bill:

Senate Republicans copied key parts of New York Gov. Andrew Cuomo’s controversial corporate immunity law and pasted it word-for-word into their new coronavirus relief proposal released on Monday. The provision could shield health care industry CEOs, executives and corporate board members from COVID-related lawsuits in the event that their business decisions end up injuring or killing health care workers and patients.

Among all federal lawmakers running for reelection in 2020, Republican Senate Majority Leader Mitch McConnell is the top recipient of campaign cash from the hospital and nursing home industries. One of the biggest career donors to Texas GOP Sen. John Cornyn — the author of the bill — is a private equity firm that owns one of the nation’s largest hospital staffing companies. Additionally, a super PAC defending Senate Republican incumbents also just received $10 million from a private equity billionaire whose firm owns another major medical staffing conglomerate.

Executives from those industries stand to benefit from the corporate immunity provision that Senate Republicans spliced into their legislation.

………

………

TMI previously reported that in April, Cuomo worked with a major health care industry lobby group to slip language into his state’s budget designed to block lawsuits against hospitals and nursing homes during the pandemic, as the casualty count exploded in New York. The provisions did not just cover frontline health care workers — it included language extending that protection to any ”health care facility administrator, executive, supervisor, board member, trustee,” or other corporate manager.

Cuomo pushed the provision after his political machine received more than $1 million from the Greater New York Hospital Association.

………

“Governor Cuomo brushes aside criticism for his mishandling of nursing homes as Republican partisan politics but as it turns out he has inspired Republicans to follow his policies,” said New York Democratic Assemblyman Ron Kim, who has fought to repeal the immunity provision in New York. “Giving nursing home executives and health care corporations early blanket legal and criminal immunity was just wrong, plain and simple.”

………

………

Amid growing outrage over the corporate immunity law, Democratic lawmakers in Albany passed Kim’s bill to narrow their state’s liability shield.

But if Senate Republicans pass their legislation in Washington, the New York statute will effectively become the law of the land in every state in the country.

“Rat Faced Andy” Cuomo is a cancer on the Democratic party.

This Happened to Me

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When I was 19, I was feeling out of it, and had extremely swollen lymph-nodes.

I went to my college health services, and they said that it was nothing to worry about, it was just allergies. (It was fairly classic mononucleosis symptoms, which is one thing that college health services should catch, but they didn’t)

8 months later, and my pre-employment physical, ironically at a hospital working with blood samples, they detected that my eosinophil count was through the roof, and after a number of tests, they determined that I had hepatitis.

I was in treatment for about 3 years afterwards, first with steroids, and then immune suppressants. (My liver numbers have been good for about 35 years)

If they hadn’t caught it, I would probably been in liver failure in a decade, because I was otherwise asymptomatic. (Well, I did lose some weight, see this picture from my employee ID at New England Medical Center)


My Best Picture Ever

Well, now the Washington Post has taken a look at college health centers, and found a profoundly troubling standard of care:

After days of sharp pain shooting up her left abdomen, Rose Wong hobbled from her history class to the student health center at Duke University.

A nurse pressed on the 20-year-old’s belly and told her it felt like gas. Wong questioned the diagnosis but said the nurse dismissed her doubts and sent her to the campus pharmacy to pick up Gas-X that afternoon in February 2019.

The next morning, Wong doubled over in pain, and a roommate drove her to a nearby emergency room in Durham, N.C. In the hospital, doctors discovered her condition was far more serious: Her left kidney had a massive hemorrhage. The bleeding, she later learned, was caused by a cancerous tumor that required surgery and chemotherapy and forced her to miss an entire school year.

Wong said she worries that when she returns to the Duke campus next month, the university and its medical clinic will be incapable of keeping her and 15,500 other Duke students healthy and safe in the middle of the coronavirus pandemic.

Except for the severity of the actual condition, this exactly mirrors my experience.

………

Wong’s misdiagnosis at Duke is among the scores of problems documented by The Washington Post at college health centers nationwide. As millions go back to school during the pandemic, the ability of campus health services to safeguard and care for students will be tested as never before — and many colleges appear unprepared for the challenge.

To assess the landscape of student health services at roughly 1,700 four-year residential campuses, The Post interviewed more than 200 students, parents and health officials and examined thousands of pages of medical records and court documents and 5,500 reviews of student health centers posted on Google.

College students reported they commonly waited days or weeks for appointments and were routinely provided lackluster care. Dozens of students ended up hospitalized — and some near death — for mistakes they said were made at on-campus clinics, including misdiagnosed cases of appendicitis at Kansas State University and meningitis at the University of Arkansas.

………

Student health centers are akin to the Wild West of medical care. There are no national regulations, and most are not licensed by states. Only about 220 campus medical clinics of the thousands nationwide are accredited by outside health organizations as meeting best practices, according to a Post analysis. In one case, Georgetown University stated on its website that its student health center was accredited but removed the claim after being asked about it by reporters.

Georgetown lied about the accreditation of its health services?

Georgetown?

University leaders are publicly lobbying for federal protections from coronavirus-related lawsuits when they reopen, arguing that costly litigation would take away from already scarce resources needed to support students.

College health officials, meanwhile, are privately discussing insufficient stockpiles of personal protective equipment, inadequate access to coronavirus testing on campus and a short supply of rooms to quarantine students, according to interviews, emails and presentations reviewed by The Post.

………

In an email last year, the chief executive of the American College Health Association cautioned members about sharing information with The Post and referenced its reporting about a viral outbreak at the University of Maryland. The association later said the message was sent to inform colleges and took no position on whether universities should comply with the requests.

This is what comes from running colleges like business, and hiring legions of overpaid management types to run them.

Franco’s Misbegotten Spawn

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This is not a surprise.  Spain’s People’s Party (PP) is a direct successor to Franco’s fascists, and sacrificing civilians to political expediency is in their blood:

By the time Spain’s prime minister, Pedro Sánchez, declared a state of alarm on March 14, the deadly coronavirus had already begun to infiltrate and rip through many of the nursing homes across the nation’s capital. Like sitting ducks, the highest risk members of society didn’t stand a chance.

Thousands died all alone; in Madrid, several were found lifeless in their beds by soldiers who had been drafted to disinfect the area. Many were carted off to the city’s ice rink, by that time converted into a makeshift morgue. Families were unable to say goodbye.

Those in nursing homes lucky enough to avoid the virus have been unable to step out into the world for over three months. The situation has been likened by many to incarceration. The mental and physical toll has been tremendous.

Yet Madrid’s right-wing regional government seems to have washed its hands of the problem, mudslinging in parliament in order to divert the discussion from this tragic situation. Spaniards are indignant at its failings. But now we must examine why elderly people can be so easily discarded, just because they’re no longer contributing to the economy.

………

In Spain, whose healthcare system is decentralized across its seventeen autonomous regions, the overall figure for care home deaths alone is said to be close to twenty thousand — more than double Germany’s entire death toll.

………

Madrid, a region that has been governed by the conservative People’s Party (PP) since 1995, accounts for around 32 percent of the country’s COVID-19 deaths, while representing only 14 percent of its population.

This was no natural disaster. Years of closures and cuts left the region ill-equipped to face the gravest humanitarian crisis to hit the country since the 1936 civil war.

………

The mounting death toll in nursing homes was initially lost in the widespread frenzy and panic that gripped Spain as the infection curve continued to soar. But now the dust has settled — 48 new cases were detected in Spain on Sunday, June 14; a month ago this figure was 849 — and the harrowing truth has emerged.

It has now come to light that the regional health ministry emailed nursing homes across the Madrid region instructing them to prevent patients of a certain condition, or indeed patients over a certain age, from being hospitalized.

Ayuso claims that the original communication was merely a draft that was released “by mistake.”

El País newspaper, however, reports that Carlos Mur de Víu, director general of social and health coordination, sent at least four emails, on March 18, 20, 24, and 25, to the Ministry of Social Policies. These provided the guidance that hospitals and residences followed, ruling out the hospitalization of disabled and elderly patients with COVID-19.

If one “draft” email may indeed have been released in error, Mur de Víu’s actions clearly show the type of strategy that was deployed. As hospitals edged ever closer to the breaking point, it became a matter of survival of the fittest. The voiceless elderly were an easy sacrifice.

………

Ayuso claims that the original communication was merely a draft that was released “by mistake.”

El País newspaper, however, reports that Carlos Mur de Víu, director general of social and health coordination, sent at least four emails, on March 18, 20, 24, and 25, to the Ministry of Social Policies. These provided the guidance that hospitals and residences followed, ruling out the hospitalization of disabled and elderly patients with COVID-19.

………

186 nursing homes in Spain are currently being invested by the public prosecutor’s office — almost half of them in the Madrid region.

………

In a cruel twist, showing once again that social inequality often lasts from the cradle to the grave, it has been reported that elderly people who were able to afford private health insurance were not denied hospital treatment. Íñigo Errejón, leader of Más País, tweeted: “This is the freedom of the neoliberals. You’re left to die if you have no money, you’re allowed to save yourself if you pay. Shameless.”

Franco’s bastards.

McKinsey Being McKinsey

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McKinsey and Company has a reputation as being an ethical consultant.

For the life of me, I do not know why.

We have seen it aiding corrupt politicians and businessmen steal from the taxpayers, and now they are managing bailouts to hospitals while instructing their hospital clients about how to game the system.

This is classic McKinsey.  Their job is not about ethics, or even good management, it is about placing an ethical gloss on self-dealing, corruption, and looting:

The global consulting firm McKinsey, which has been tapped by the Department of Health and Human Services to help manage and audit billions of dollars in coronavirus relief for hospitals, has worked for at least 10 hospitals and chains that have received federal recovery funds, according to tax records and other public disclosures.

McKinsey was hired to help manage the program and establish audit procedures for the funds, according to the contract award, which was granted in late April and is worth $4.9 million.

The majority of the $175 billion in funds had yet to be paid out to hospitals when McKinsey was hired, though McKinsey denied playing any role in deciding which hospitals received funds. Among those that have already received payments are at least 10 hospitals and chains that have in recent years retained McKinsey & Co.’s extensive health care business, which employs more than 1,700 consultants. The hospitals have paid as much as $20 million for McKinsey’s services in a single year as they seek to streamline costs and boost revenue, according to public disclosures.

By, “Streamline costs and boost revenue,” they mean firing lots of people, price gouging, and reducing patient safety.

That’s in addition to using their inside position in monitoring the fund to help their clients to get a jump in the line.

Maybe when we talk about jailing bankers, we should add their consultants to the list.

What Happens When You Treat Your Staff like Crap for Years

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After years of cuts, many of the staff of Britain’s National Health Service (NHS) are not favorably inclined toward their current, or former employer, and so many of the retired staff are disinclined to return temporarily to help deal with the COVID-19 crisis:

Scores of retired NHS doctors and nurses have told the Guardian that they are against returning to work to help tackle coronavirus, with many saying it would threaten their physical and mental health. The government confirmed contingency plans on Tuesday to call back to work NHS “leavers and retirees” to help relieve pressure on an NHS workforce that is expected to be overwhelmed by the virus.

But a majority of 120 former NHS employees who responded to a Guardian callout were resistant, and in some cases hostile, to the idea. Many respondents said unprompted they did not want to a return to a working environment where they suffered stress, bullying, burnout and even breakdowns.

Seventy-one said they would not be happy to return to work, with many expressing their reluctance in vehement terms. “After the way I was treated I would rather shove a rusty six-inch nail up my backside than return to my old job,” said a 67-year-old former staff nurse from Manchester.

This is what happens when you are in an organization that has systematically been defunded, demonized, and privatized for decades.

Once you go back, you do not want to get back in.

NHS has been Americanized, and now it has a disgruntled staff, and former staff, who unlikely to go that extra mile in an emergency.

Profoundly Depressing Quote of the Day

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But that will be a heavy lift indeed with a health care system geared above all to price-gouge sick people out of as much money as possible.

—Ryan Cooper at The Week explaining just why America is not equipped to handle COVID-19

Between millions with no sick leave, a healthcare system which is primary about looting, no meaningful childcare, and a public health system which has been shut down and privatized over the past 40 years.

Seriously, Bulgaria is probably better equipped to handle something like this than the United States is.

In Preparation for the Debates, Here is a Medical Study

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It’s from The Lancet, and it shows that Bernie Sanders’ Medicare for all plan more than pays for itself:

Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.

When they ask Sanders, “How will you pay for this?”, his response, “How can you pay for not doing this?”

Unsurprising News Out of Germany

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And better yet, it does not involve the rise of fascism in the country.

A study in Germany has shown that the inclusion of a private option in parallel with public health insurance raises costs for everyone:

German residents would save an average of €145 ($157) per year on health insurance costs if the privately insured paid into one statutory health insurance system, according to a study published on Monday by the IGES Institut in Berlin.

Privately insured people living in Germany — top earners, public officials and high-income self-employed workers — earn on average 56% more than publicly insured people, the survey found. The study, commissioned by the German non-profit Bertelsmann Foundation, estimates that the public health insurance system would have between €8.7 billion and €10.6 billion of added revenue if the privately insured paid into it.

Even if the fee losses incurred by doctors as a result of the abolition of private health insurance were compensated, the study said, each insured German resident would save an average of €48 annually.

The study based its estimates on the 2016 data, the most recent data available, from an annual survey of around 12,000 households. In 2016, around 8.8 million German residents were privately insured, a similar total to now, while 70.4 million had the statutory health insurance system — that figure currently sits at 73.2 million.

Private for profit insurance makes healthcare better exactly never.

This is an Interesting Life Hack

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It turns out that you can reduce an emergency room bill by thousands of dollars by demanding an itemized bill:

Having a medical emergency is hard enough as it is, and anyone would be scared in that position. However, most Americans have a lot more to worry about during a visit to the ER than many other people from developed countries. According to the nonprofit Health Care Cost Institute (HCCI), the cost of ER visits are on the rise. The organization has examined a decade’s worth of insurance claims for hospital emergency room bills, and determined that from 2008 to 2017 the prices have substantially increased. HCCI discovered that the average ER visit now costs $1,389 and has reached a 176% increase over the decade.

Recently, a woman shared an important tip that helped her reduce her ER bill

Broooooo I went to the ER a while ago and got a huge bill over 1,000. I saw a tiktok stating that if you ask for an itemized bill they reduce it and so I called and asked for 1 and just got it and bitch I don’t owe shit now 😭

— ehvuh (@the_heva) December 28, 2019



While those who have insurance are not always made to pay full price, the uninsured people suffer the most. This prompts people to look for a way to reduce their bills. After TikTok user shaunnaburns3 told people to ask hospitals for itemized bills once they are faced with a hefty charge for a trip to the ER, people decided to put that to the test. Luckily, for some people, this tip actually worked and helped save them hundreds of dollars.

I’m not sure if this actually works, but it certainly is worth a try.

It Never Is

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A study in the New England Journal of Medicine shows that hospital mergers do not improve patient outcomes.

In fact it results in worse outcomes.

This should surprise no one.  It is the way of mergers and acquisitions:

Hospitals continue to turn to M&A to navigate tricky industry headwinds, including lowering reimbursement and flatlining admissions as patients increasingly turn to alternate, cheaper sites of care. Provider trade associations maintain consolidation lowers costs and improves operations, which trickles down to better care for patients.

………

Thursday’s study analyzed CMS data on hospital quality and Medicare claims from 2007 through 2016 and data on hospital M&A from 2009 to 2013 to look at hospital performance before and after acquisition, compared with a control group that didn’t see a change in ownership.

American Hospital Association General Counsel Melinda Hatton took aim at the study’s methods to refute its findings, especially its reliance on a common measure of patient experience called HCAHPS.

………

The results contradict a widely decried AHA-funded study last year conducted by Charles River Associates that found consolidation improves quality and lowers revenue per admission in the first year prior to integration. The research came quickly under fire by academics and patient advocates over potential cherrypicked results.

A spate of previous studies found hospital tie-ups raise the price tag of care on payers and patients. Congressional advisory group MedPAC found both vertical and horizontal provider consolidation are correlated with higher healthcare costs, the brunt of which is often borne by consumers in the form of higher premiums and out-of-pocket costs.

There is nothing that the finance industry, which makes bank on fees from M&A activity, cannot ruin.

It’s Called Shoe Leather Journalism

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It turned out that they were dealing with a community that was hard to reach and dubious of journalists, but instead of throwing up their hands in despair, their team rolled up their sleeves, went to work, and listened to potential sources.

This is an anathema to journalists who dream of meeting “Deep Throat” in a parking garage, or who want make stories out of trial balloons from politicians, but they got their story, and the abuse stopped:

In August, we spent an evening hand-addressing more than 200 letters, mostly to residents of Memphis, Tennessee. The city is the second-poorest large metropolitan area in the country, with nearly 1 in 4 residents living below the poverty line. About half of the letter recipients had been sued by a private-equity backed doctors group because of unpaid medical bills. The other half had been sued by a separate company.

Our team, led by reporter Wendi C. Thomas of MLK50: Justice Through Journalism, was investigating the way large institutions profit off people who are poor in Memphis. She had already reported that Methodist Le Bonheur Healthcare, the area’s largest hospital system, had aggressively sued poor people — and the hospital quickly suspended the practice.

Several other companies also were filing lawsuits against people unable to pay their bills. Court records showed us who these people were, but we didn’t know what these debts meant for their lives. We knew letter-writing alone wouldn’t be enough to connect with people, but it was a start.

After we put our letters in the mail, we continued to try to reach people who had been sued by posting flyers in neighborhoods, making dozens of calls (and getting hung up on plenty of times) and speaking to community leaders.

We understood, through research, that many journalists have historically covered these communities in extractive and self-serving ways, partly because of resource constraints and partly because many aren’t from the communities they cover. Our partners launched MLK50 to break patterns like these. We hoped deliberate engagement would result in real change for the people we reached.

It worked. Even before our story on the doctors group was published with MLK50, the company said it, too, would stop suing its patients.

………

Lessons

  1. You can still do engagement reporting on a topic people don’t like to talk about. But don’t underestimate the amount of work it takes to do it right.
    ………
     
  2. Be specific about who you’re trying to reach. Don’t expect to reach everyone. They don’t owe you anything.
    ………
     
  3. Be specific about who you’re trying to reach. Don’t expect to reach everyone. They don’t owe you anything.
    ………

Read the whole thing.

It’s not just a demonstration of good journalism, it’s an indictment of how much of journalism is practiced today.

Unleashing the Power of the Private Sector

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It turns out that putting Medicaid under private management in Iowa has tripled the price increases compared to previous years.

The private sector is to the efficient administration of healthcare what Ebola is to French kissing:

The average cost of insuring an Iowan on Medicaid has climbed nearly three times as fast since the state hired private companies to manage the program, when compared to the previous six years, new state figures show.

Since fiscal 2017, the first full year of privatization, the per-member cost of Iowa’s Medicaid program has risen an average of 4.4 percent per year, according to the non-partisan Legislative Services Agency. In the previous six years, the per-member cost rose an average of 1.5 percent per year, the agency said.

The new cost figures come amid continuing controversy over whether Iowa should have hired private companies to run the $5 billion program. The shift’s supporters said it would slow growth in health care spending on the more than 600,000 poor or disabled Iowans covered by Medicaid.

The Legislative Services Agency compiled the new cost increase figures from past budget reports published by the Department of Human Services, which oversees Medicaid.

………

The Medicaid cost increases for this fiscal year are partly driven by an 8.4 percent raise the Iowa Department of Human Services agreed last month to give the two managed-care companies running the program. That raise, which includes state and federal tax dollars, will send $344 million more to Amerigroup and United Healthcare this fiscal year, which runs through June 2019.

So, spending millions of dollars on private management don’t end up saving money.

Hoocoodanode?

Not Enough Bullets

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Literally the Least Tufts Could Do

The Sackler family, are having major butt-hurt because Tufts University is pulling their names from their buildings.

Let’s see, you created a dangerous product, aggressively and dishonestly marketed it across the nation, when caught you looted your company in advance of your bankruptcy, and your non-bankrupt foreign company is STILL trying to hook people on your poison.

Why wouldn’t an institution best known for its medical program want to have anything with you?

The Sackler family is pushing back after Tufts University removed the family name from its buildings and programs due to the family’s link to the ongoing opioid epidemic, according to a report in The New York Times.

In a letter to Tufts’ president, a lawyer for the family wrote that the removal was “contrary to basic notions of fairness” and “a breach of the many binding commitments made by the University dating back to 1980 in order to secure the family’s support, including millions of dollars in donations for facilities and critical medical research.”

Tufts made the decision to remove the family name after getting the results of an independent review of the university’s relationship with the Sacklers and OxyContin-maker Purdue Pharma, which the Sacklers own. Both the family and the company have been accused of helping to spark the crisis by aggressively marketing the powerful painkiller and misleading doctors, patients, and regulators about its addictiveness.

………

The review found that Purdue did intend to use the relationship to advance its interests. And, according to the report, in some cases, it was successful in influencing the academic institution. “Moreover, we conclude that there was an appearance of too close a relationship between Purdue, the Sacklers, and Tufts,” the report said.

The letter from the Sackler family lawyer hinted at the possibility of legal action.

………

Although, not all of the Sackler family is involved with OxyContin. Of the original three Sackler brothers involved in Purdue, one of them—Arthur—died before the painkiller was introduced, and his brothers bought out his stake in the company. Arthur’s widow, Jillian Sackler, released a statement saying in part, “It deeply saddens me to witness Arthur being blamed for actions taken by his brothers and other OxySacklers.”

OxySacklers.  Heh.