In his career, Jim Lott has helped develop health care policy
development, advocacy, and association communications for
hospitals serving Los Angeles, Orange, San Bernardino, Riverside,
Santa Barbara and Ventura counties. With his extensive history in
health care public policy, Jim brings an insider’s perspective to
his analysis of current health policy issues.
This will be my last post, as I am leaving HASC at the end of
next month. Health is fine, work is great, just moving on
to the next chapter of my life, which will be in health care…what
else would I do?
I have enjoyed writing this blog, and I thank all of you who have
told me that you like reading what I write. I will truly
miss doing this.
Again, I’m still at HASC until May 31, so drop me a line or
call. After I leave, you may reach me on my cell at
213-324-3262 or by email at JLottSr@me.com.
The Society of Actuaries
(SOA) recently predicted health insurance costs in the individual
market would increase 32% by 2017. Not good news,
especially considering that the blame for this increase was
placed at the doorstep of the Accountable Care Act (ACA).
Contrary to the expectations of those who developed the new
reform laws, the SOA asserts that this increase is in part due to
the poor health status of the new enrollees now eligible under
the ACA.
Most would agree that cutting health care costs requires more
active participation of the consumer in medical decision making.
It’s a cost driver the Affordable Care Act (ACA) fails to
address.
The use of social media by consumers to both look up as well as
leave performance reviews on the purchases we make and the
services we use is growing exponentially. That use was expanded
last week with the
U.S.Securities and Exchange Commission’s (SEC) decision to
permit companies to disclose material information to investors,
as long as they have previously alerted investors that they will
be doing so.
Six years ago, I wrote about the emergence of retail clinics as
“…The Next New Thing” in the delivery of
health care. Even then, for almost 10 years these
enterprises had been offering basic medical care in drug stores
in nearly half the states in the country at about 12 percent of
the cost of an emergency room visit and a third of the cost of a
visit to an urgent care center.At the time, the California Health
Care Foundation opined that, “If successful, this could change
the way many people receive routine, non-urgent medical care,
with significant implication
In my last blog, I summarized
the plan to move Medicare/Medi-Cal-covered patients residing
in eight California counties into a system of coordinated
care. The move would make California the fifth
dual-eligibles coordinated care project in the nation. In no
particular order, the following demographics about plan enrollees
worry me:
Last week, federal and state officials released their
long-anticipated Memorandum of Understanding (MOU) implementing a
three-year effort to lower costs and improve the coordination of
medical care provided to nearly half a million California seniors
who are enrolled in both Medicare and Medi-Cal. If approved
by the feds, passive enrollment of program beneficiaries over a
12-to-18-month period will start in seven counties (Orange,
Riverside, San Bernardino, San Diego, San Mateo, Alameda and
Santa Clara) in October. What this means is that the
dual-eligible program beneficiaries
Starting in January, the federal Affordable Care Act (ACA) will
require all residents to secure health insurance or pay a $95 tax
penalty, assessed only if the filer qualifies for a federal tax
return.
A physician specialist that I see regularly ordered a diagnostic
test to check on my medical condition. He explained to me
that two tests were available and he disclosed which of the two
he preferred. Of course, I did what most patients do—I
chose his preference. Later I would learn that his
preference cost almost twice as much as the other test and that I
would have to pay more than $500 for the part of the bill not
paid by my health plan. I hasten to add that I am not upset
with my doctor. Rather, I am ticked off at myself and my
health plan for how this play
A belief I regard highly is, “That government is best which
governs least,” a quote historians have attributed equally to
Henry David Thoreau and Thomas Jefferson. Mind you, the
operative meaning or the verb infinitive in the quote is “to
govern.” Few who have been paying attention to the gridlock in
our nation’s capital give high marks to our elected
representatives for meeting this core job requirement. In
fact, one credible poll gives Congress an approval rating of only
14 percent, with the Obama Administration receiving only slightly
higher marks.
In my January 24th blog post, Taming
Medicare’s Budget Appetite, I mentioned Watson, IBM’s
supercomputer Wellpoint purchased to help medical practitioners
make diagnoses and prescribe treatment plans. Not satisfied with
beating the two top Jeopardy game show champions, Watson has been
busy learning how to be the best doctor on the planet.
We’ve all heard this one. When asked about Congress or our
state legislature, voters give low performance ratings to both
followed by, “but my representative is a good guy.” It
would seem that the same holds true about constraining the growth
of health care costs.
I learned what that meant when as a third grader my mother moved
me to a private Catholic school from an economically depressed
inner-city public school where 70 percent of the students never
made it to high school graduation and where the majority of those
who did were sub-literate.
Demand for emergency room care in California has increased by 26
percent over the last decade while capacity has remained flat or
declined in most service areas. Accordingly, some health care
analysts recommend that hospitals be allowed to operate
freestanding emergency departments (FEDs) to help meet a growing
need in the state. FED supporters also believe that the enactment
of health care reform will put greater stress on existing
hospital emergency departments because as many as 40 hospitals in
California, most with emergency rooms, will close in the coming
years.
Almost one person in five in the U.S. speaks a language other
than English at home, and half of them have limited English
proficiency (LEP). Federal laws and standards require
language assistance, including bilingual staff and interpreter
services, be provided by health care organizations receiving
federal funds.
“… and pretty soon you’re talking real money.” The late Senator
Everett Dirksen (R-IL), a politician who often spoke passionately
about the debt ceiling, federal spending and the growth of
government, is rumored to have made this statement to reporters
about the way Congress thinks about the federal budget.
Well, the Rand Corporation may have found a billion dollars that
can be taken off our nation’s yearly health care tab.
No U.S. resident under the age of 27 can say that he or she has
experienced a year of life where the average weather temperature
was below that of the previous year. Climate change, or to
be more accurate, global warming, is real.
With men outpacing women, almost two-thirds of adults in our
country are overweight, and slightly more than one-in-three are
clinically obese, meaning that they have a body mass index (BMI)
greater than 30. With boys outpacing girls, almost one-in-five of
our children are obese. Clearly, males lag behind females
in maintaining healthy weight profiles. It is also important to
note the positive correlation between low socioeconomic status
and obesity.
Substitute “physician assistant” or “pharmacist” in this phrase,
and this may become a commonplace introduction patients seeking
medical care will hear in the future. Why?
Legislatures throughout our nation are looking for ways to bridge
a looming shortage of doctors caused by the approaching exodus of
aging physicians and the increased demand for access to
physician-led care by millions of newly-insured Americans,
courtesy of the federal Patient Protection and Affordable Care
Act (PPACA) enacted in 2010.
The federal health care reform law enacted in 2010 – the Patient
Protection and Affordable Care Act (PPACA) – excluded illegal
immigrants from eligibility for inclusion under its expanded
health insurance coverage provisions. Now it would appear that
health coverage for these immigrants will not be in the
immigration reform plan the White House and Congress will likely
hammer out later this year.
In California, 54 percent of health care coverage provided to
residents under 65 is sponsored by our state’s employers, down
from 61 percent prior to enactment of the federal law in 2010.
Last week, the nonpartisan Congressional Budget Office (CBO)
advised Congress that seven million fewer Americans were forecast
to have employer-sponsored health insurance in 2022 due to the
federal Patient Protection and Affordable Care Act (PPACA). The
estimate is up from August, when the CBO predicted a drop of four
million people with employer-sponsored plans.
Last week, the Internal
Revenue Service (IRS) and the Health and
Human Services Agency (HHS) published rules governing the
individual mandate that, according to
HealthLeaders Media, “include such extensive exemptions that
only 2% of the population would owe a penalty, or ‘shared
responsibility payment’ for not having coverage under a health
plan.”
There is no employer mandate to provide health insurance coverage
under the Patient Protection and Affordable Care Act (PPACA)
passed in 2010, but there is a stick in the form of a
$2,000-per-year/per-worker penalty hovering over the heads of a
minority of California businesses with more than 50 company
employees. The penalty will be assessed starting with the
31st worker and beyond.What this means is that the requirement to
either provide health insurance or pay a penalty does not apply
to 5.7 million out of 6 million (96 percent) of the registered
businesses in California.
The December 31st
Ventura County Star news report that Community Memorial
Health System (CMHS) will no longer hire people who use
tobacco gets my vote for the best New Year’s resolution made by a
health care organization.
A prominent retirement investment planning firm cites two
lifespan statistics in its advertising campaign that, if true,
will stun to death any efforts to rein in the aggregate growth of
what we spend as a nation on health care. “One in three
people born today will live to be 100 years old,” says one
billboard. “The first person who will live to be 150 years
old is alive today,” says another. Thought-provoking ads,
both, and the health care cost implications of such a trend are
breathtaking.
Lott has left the building!
Dear readers:
This will be my last post, as I am leaving HASC at the end of next month. Health is fine, work is great, just moving on to the next chapter of my life, which will be in health care…what else would I do?
I have enjoyed writing this blog, and I thank all of you who have told me that you like reading what I write. I will truly miss doing this.
Again, I’m still at HASC until May 31, so drop me a line or call. After I leave, you may reach me on my cell at 213-324-3262 or by email at JLottSr@me.com.
Health Care Reform Stumbles
The Society of Actuaries (SOA) recently predicted health insurance costs in the individual market would increase 32% by 2017. Not good news, especially considering that the blame for this increase was placed at the doorstep of the Accountable Care Act (ACA). Contrary to the expectations of those who developed the new reform laws, the SOA asserts that this increase is in part due to the poor health status of the new enrollees now eligible under the ACA.
Are you addressing your patients’ CRFs?
Most would agree that cutting health care costs requires more active participation of the consumer in medical decision making. It’s a cost driver the Affordable Care Act (ACA) fails to address.
Crowd-Source Reviews vs. Patient Satisfaction, Quality and Outcomes Reports
The use of social media by consumers to both look up as well as leave performance reviews on the purchases we make and the services we use is growing exponentially. That use was expanded last week with the U.S.Securities and Exchange Commission’s (SEC) decision to permit companies to disclose material information to investors, as long as they have previously alerted investors that they will be doing so.
Retail Clinics: The Next Generation
Six years ago, I wrote about the emergence of retail clinics as “…The Next New Thing” in the delivery of health care. Even then, for almost 10 years these enterprises had been offering basic medical care in drug stores in nearly half the states in the country at about 12 percent of the cost of an emergency room visit and a third of the cost of a visit to an urgent care center.At the time, the California Health Care Foundation opined that, “If successful, this could change the way many people receive routine, non-urgent medical care, with significant implication
A Yellow Flag for Dual-Eligibles Conversion
In my last blog, I summarized the plan to move Medicare/Medi-Cal-covered patients residing in eight California counties into a system of coordinated care. The move would make California the fifth dual-eligibles coordinated care project in the nation. In no particular order, the following demographics about plan enrollees worry me:
Plan to Change Dual Eligibles Program Advances
Last week, federal and state officials released their long-anticipated Memorandum of Understanding (MOU) implementing a three-year effort to lower costs and improve the coordination of medical care provided to nearly half a million California seniors who are enrolled in both Medicare and Medi-Cal. If approved by the feds, passive enrollment of program beneficiaries over a 12-to-18-month period will start in seven counties (Orange, Riverside, San Bernardino, San Diego, San Mateo, Alameda and Santa Clara) in October. What this means is that the dual-eligible program beneficiaries
Covered California Gets Creative
Starting in January, the federal Affordable Care Act (ACA) will require all residents to secure health insurance or pay a $95 tax penalty, assessed only if the filer qualifies for a federal tax return.
The Obfuscation Plan
A physician specialist that I see regularly ordered a diagnostic test to check on my medical condition. He explained to me that two tests were available and he disclosed which of the two he preferred. Of course, I did what most patients do—I chose his preference. Later I would learn that his preference cost almost twice as much as the other test and that I would have to pay more than $500 for the part of the bill not paid by my health plan. I hasten to add that I am not upset with my doctor. Rather, I am ticked off at myself and my health plan for how this play
To govern or not to govern …
… That is the question.
A belief I regard highly is, “That government is best which governs least,” a quote historians have attributed equally to Henry David Thoreau and Thomas Jefferson. Mind you, the operative meaning or the verb infinitive in the quote is “to govern.” Few who have been paying attention to the gridlock in our nation’s capital give high marks to our elected representatives for meeting this core job requirement. In fact, one credible poll gives Congress an approval rating of only 14 percent, with the Obama Administration receiving only slightly higher marks.
Dr. Watson, I Presume?
In my January 24th blog post, Taming Medicare’s Budget Appetite, I mentioned Watson, IBM’s supercomputer Wellpoint purchased to help medical practitioners make diagnoses and prescribe treatment plans. Not satisfied with beating the two top Jeopardy game show champions, Watson has been busy learning how to be the best doctor on the planet.
Do Consumers Care About Cutting Health Care Costs?
We’ve all heard this one. When asked about Congress or our state legislature, voters give low performance ratings to both followed by, “but my representative is a good guy.” It would seem that the same holds true about constraining the growth of health care costs.
Reflections of a Hospital Lobbyist
“Expect more!”
I learned what that meant when as a third grader my mother moved me to a private Catholic school from an economically depressed inner-city public school where 70 percent of the students never made it to high school graduation and where the majority of those who did were sub-literate.
Are Freestanding Emergency Rooms Good for California?
Demand for emergency room care in California has increased by 26 percent over the last decade while capacity has remained flat or declined in most service areas. Accordingly, some health care analysts recommend that hospitals be allowed to operate freestanding emergency departments (FEDs) to help meet a growing need in the state. FED supporters also believe that the enactment of health care reform will put greater stress on existing hospital emergency departments because as many as 40 hospitals in California, most with emergency rooms, will close in the coming years.
Health Care Lost in Translation
Almost one person in five in the U.S. speaks a language other than English at home, and half of them have limited English proficiency (LEP). Federal laws and standards require language assistance, including bilingual staff and interpreter services, be provided by health care organizations receiving federal funds.
“A billion here, a billion there …”
“… and pretty soon you’re talking real money.” The late Senator Everett Dirksen (R-IL), a politician who often spoke passionately about the debt ceiling, federal spending and the growth of government, is rumored to have made this statement to reporters about the way Congress thinks about the federal budget. Well, the Rand Corporation may have found a billion dollars that can be taken off our nation’s yearly health care tab.
The Untold Impact of Climate Change on Population Health and Health Care Costs
No U.S. resident under the age of 27 can say that he or she has experienced a year of life where the average weather temperature was below that of the previous year. Climate change, or to be more accurate, global warming, is real.
Constraining the Growth in Health Care Costs is A Weighty Problem
With men outpacing women, almost two-thirds of adults in our country are overweight, and slightly more than one-in-three are clinically obese, meaning that they have a body mass index (BMI) greater than 30. With boys outpacing girls, almost one-in-five of our children are obese. Clearly, males lag behind females in maintaining healthy weight profiles. It is also important to note the positive correlation between low socioeconomic status and obesity.
“Mr. Jones, the nurse practitioner will see you now.”
Substitute “physician assistant” or “pharmacist” in this phrase, and this may become a commonplace introduction patients seeking medical care will hear in the future. Why? Legislatures throughout our nation are looking for ways to bridge a looming shortage of doctors caused by the approaching exodus of aging physicians and the increased demand for access to physician-led care by millions of newly-insured Americans, courtesy of the federal Patient Protection and Affordable Care Act (PPACA) enacted in 2010.
Illegal Immigrants Denied Health Coverage Aid Again
The federal health care reform law enacted in 2010 – the Patient Protection and Affordable Care Act (PPACA) – excluded illegal immigrants from eligibility for inclusion under its expanded health insurance coverage provisions. Now it would appear that health coverage for these immigrants will not be in the immigration reform plan the White House and Congress will likely hammer out later this year.
Pace to Government-Sponsored Health Insurance for All Hastens
In California, 54 percent of health care coverage provided to residents under 65 is sponsored by our state’s employers, down from 61 percent prior to enactment of the federal law in 2010. Last week, the nonpartisan Congressional Budget Office (CBO) advised Congress that seven million fewer Americans were forecast to have employer-sponsored health insurance in 2022 due to the federal Patient Protection and Affordable Care Act (PPACA). The estimate is up from August, when the CBO predicted a drop of four million people with employer-sponsored plans.
Individual Mandate: Not So Much a Mandate Anymore
Last week, the Internal Revenue Service (IRS) and the Health and Human Services Agency (HHS) published rules governing the individual mandate that, according to HealthLeaders Media, “include such extensive exemptions that only 2% of the population would owe a penalty, or ‘shared responsibility payment’ for not having coverage under a health plan.”
Health Care Reform’s Impact on Employers: Myths, Misconceptions and Consequences
There is no employer mandate to provide health insurance coverage under the Patient Protection and Affordable Care Act (PPACA) passed in 2010, but there is a stick in the form of a $2,000-per-year/per-worker penalty hovering over the heads of a minority of California businesses with more than 50 company employees. The penalty will be assessed starting with the 31st worker and beyond.What this means is that the requirement to either provide health insurance or pay a penalty does not apply to 5.7 million out of 6 million (96 percent) of the registered businesses in California.
A Back-To-Basics Health Care Cost Containment Strategy Whose Time Has Come…Again
The December 31st Ventura County Star news report that Community Memorial Health System (CMHS) will no longer hire people who use tobacco gets my vote for the best New Year’s resolution made by a health care organization.
Taming Medicare’s Budget Appetite, Part 2
A prominent retirement investment planning firm cites two lifespan statistics in its advertising campaign that, if true, will stun to death any efforts to rein in the aggregate growth of what we spend as a nation on health care. “One in three people born today will live to be 100 years old,” says one billboard. “The first person who will live to be 150 years old is alive today,” says another. Thought-provoking ads, both, and the health care cost implications of such a trend are breathtaking.