Insight, analysis & opinion from Joe Paduda

Oct
20

Hilarity break

Ok, it has been a really long week – mostly spent in airplanes and hotels and conference rooms. So when good friend Chazzy Stone sent me this I just had to put it up.
Mahatma Gandhi, as you know, walked barefoot most of the time, which
produced an impressive set of calluses on his feet. He also ate very
little, which made him rather frail and with his odd diet, he suffered from bad
breath. This made him (Oh, man, this is so bad, it’s good)….. A super
calloused fragile mystic hexed by halitosis.
My ribs hurt.


Oct
20

Anonymous comment policy

I’ve received several anonymous comments from readers recently, which has caused me to rethink comment policy. Here’s how these will be handled in the future.
Anonymous comments that are specific to a topic, show knowledge of that topic, and are not (overly) snarky or mean-spirited or accusatory without substantiation will probably be published. Anonymous posts that don’t meet these criteria will probably not be published.
And anonymous comments from authors that call into question my ethics will most definitely not be published. I’m quite willing to address any concerns if, and only if, the commenter has enough courage and honesty to show their (virtual) face.
I have no patience for cowards who criticize without revealing their identity and therefore enable me, and other readers, to understand the cowards’ potential biases.


Oct
19

Could McGuire be heading to the Big House?

Perhaps the insurance industry sees the scandals in Washington as a challenge, a motivating factor, a red flag thrust in front of the industry. How else to explain the daily news on malfeasance and wrongdoing on the part of insurers? Criminal indictments, revelations of unethical behavior, news of commission padding, retroactive rejection of applications, and sleazy products have all hit the mainstream media this year, and the latest may be the biggest yet.

Continue reading Could McGuire be heading to the Big House?


Oct
17

Workers’ Comp – the answer to the spinal fusion question

Kudos to USAToday for publishing a pretty good article on variations in practice patterns related to back surgeries. In a front page story today, the paper that has been derided by some as “McNews” explores the issues surrounding the explosion in the number of spinal fusions.
The reporting is balanced, insightful, and thorough, a bit of a surprise coming from a paper that prides itself on short sentences, really short words, and lots of color, not depth and nuance.
Noted throughout the article is the primary problem – no one knows how many spinal fusions are the right number, and there is significant disagreement among stakeholders re when a patient should have surgery. (free registration required) That’s all true, and that’s where workers compensation comes in.

Continue reading Workers’ Comp – the answer to the spinal fusion question


Oct
16

How much is too much?

Dr. Biill McGuire, Chairman and CEO of United HealthGroup (UHG), is leaving the company. In an answer to the old question, “how much is too much?”, the answer is “$1.5 billion“.
This is, of course, the value of stock options that Dr. M received from UHG over the course of his career, a substantial portion of which were backdated to ensure he received the maximum possible payout.

Continue reading How much is too much?


Oct
13

McClellan’s parting views

Dr Mark McClellan has left his post as administrator for the Center for Medicare and Medicaid Services (CMS). On his way out he talked about the future of the Medicare program, his views on the benefits of market-based competition, and his prediction that we are in what will be known as the biomedical century.
McClellan has garnered relatively positive reviews from across the political and editorial spectrum. By all accounts he is smart, dedicated, and a good person. That last is from a reader who knows the family and respects them. While that may all be true, I’m afraid McClellan missed a great opportunity. While he has worked diligently to promote data collection, quality and performance monitoring, and investigations of pay for performance, I have not seen much direct attention paid to practice pattern variation.
That’s a big miss.


Oct
12

The provider – payer debate continues

My recent post on the battles between large health plans and hospitals/health systems generated a good bit of debate. One comment deserves special attention; “the other Joe” notes that the western PA landscape is marked by a combination health care system/health plan that dominates the region. While this type of vertical integration has been tried many times in the past with rather limited success, this version looks to be much better positioned to succeed.
But as the other Joe points out, there are significant costs associated with that “success”, costs that are borne by the system/plan’s employees, payers, insureds, patients, and employer customers.


Joe Paduda is the principal of Health Strategy Associates

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A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.

 

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