The first edition of Health Wonk Review for the year is up at the OHP blog – a well-organized and quick review of what happened while you were otherwise engaged.

A very funny edition of HWR is up at Health News Review, Gary Schwitzer’s always insightful blog on health news.
Well worth the visit!

Brad Wright’s edition of Health Wonk Review has suggestions for everyone on your list – from wonkers (that’s with an O, not an A !) to President Obama to Florida-domiciled relatives to the skeptic to the health reform repealer.
It’s kind of like Philippine boxer Manny Pacquiao, short, sweet, and packing a big punch…

The deficit battle is on and politicians are in full voice – both in Washington and out on the hustings, where GOP candidates are loudly denouncing health reform as unAmerican and a job killer. Hipsters and greying hippies are occupying Wall Street and Main Street, while Tea Partiers are claiming they hold the title of most outraged. The one percent is wondering what the 99 percenters are so upset about, while the 99 percenters are after their well-coiffed scalps.
Into the bloody fray, with nary a fear for life or health, reputation or career, plummet our worthies, those denizens of the blog-o-sphere that specialize in separating the non- from the -sense, the BS from the fertilizer, the ill-formed opinion from the logically-based interpretation!
Join us as we follow their heroic deeds, gasp as you read their trenchant and timely missives, awed by their grasp of the incredibly-esoteric and yet critically important.
Let’s get it started (cue Fergie…)
First out of the box are Shannon Brownlee and Joe Colucci of the New Health Dialogue. These erudite authors show no trepidation as they take on the opponents of the US Preventive Services Task Force, marshalling cogent, clear language to confront the fallacies of those who would condemn the USPSTF’s stance on prostate screening. Watch out, Newtster!
Closely on their heels comes Maggie Mahar, who is very concerned the USPSTF will get defunded by some knuckleheads in Congress just because some physicians, device manufacturers, and others don’t like hearing their stuff doesn’t work like they say it does. Maggie, Maggie, Maggie! Where is your faith in the goodness of mankind??
Jaan Sidorov wants to make sure we don’t get all amazed by Siri and her techno-friends; we do need people involved in the care process, even if it is telemonitoring.
At the extreme other end of the political spectrum is John Goodman, who’s ‘penned’ an intriguing treatise on what we should be doing about long term care. He has five main points, several of which I – dare I say it – actually concur with. Wonder of wonders!
Chris Langston reports from his first meeting of the Medicare Payment Advisory Commission – that rationer of care also known as MedPAC. No, it’s not a medical device company’s PAC, it’s the group that heavily influences Medicare’s payment and coverage policies. For all those who decry them durn gubmint byoorowkrats, read Chris’ post.
Big news is coming soon, with the Medicare Shared Savings Final Rule amongst the biggest (at least among us kids). Health Affairs has a multi-post entry that you can best find at their blog; discussing the key aspects of the Shared Savings program in detail. If this is your thing, click on!
Tinker Ready’s flavoring her post with a hefty dash of outrage from Boston’s Occupiers – who don’t like the private company – health insurance linkage one little bit.
From deep within the world of insurance, David Wlliams emerges with an explanation of the “Explanation of Benefits” he got from his insurance company, as explained by his provider. It’s pretty entertaining, and surprisingly well-written. Of course, anything that’s remotely readable that comes from an insurer or provider is deemed “well-written”…
On a macro scale, one topic that deserves much more consideration is population health. From that part of the wonking world comes a great post on disparities between – and some of the reasons for – health status in rural and urban areas. Thanks to Kristen Siemering for her entry!
Louise – a very experienced and highly knowledgeable insurance broker in Colorado, thinks the folks predicting the demise of the insurance broker are misguided, misinformed, and just plain wrong. There is value there, value that can’t be replaced easily or cheaply.
Another view comes from Bob Vineyard, who’s commenting on one exchange that seems to be struggling.
Trudy Lieberman’s thinking that those employer policies that don’t provide much coverage and have massive deductibles and copays are not serving employees – or their families – well.
The Insurance Exchanges are slated to play an important role in reform – and California is well on the way with their’s. After multiple meetings and much dialogue with lots of stakeholders, Linda Leu is seeing good progress.
Another perspective comes from Jason Shafrin, who thinks the exchanges may not do much to help competition as many markets are already consolidated.
Gary Schwitzer takes the mass/statistically illiterate/medically ignorant media to task in his post on media’s common mistakes – well, that’s not exactly what it’s about, but pretty close. Gary points out that what you read may well be, well, wrong.
One area that cries out for clear, cogent explanation is the whole hospital readmissions uproar. Fortunately, Bradley Flansbaum’s here to clear things up!
Your faithful author’s contribution is a treatise on what’s REALLY going on in Massachusetts post-reform. Hint – it’s been five years, and things are starting to change – a lot.
Roy Poses continues to shine his very bright light on inappropriate or concerning links between research and commercial entities – as he’s ben doing for as long as I can remember. This week he takes the NYTimes to task for not asking the tough questions about an academic institution’s desire to work more closely with private industry. Roy is great, but I hope he checks under his car before he starts it every morning.
While all the attention is on the health insurance market, Jon Coppelman hasn’t missed a big story in workers comp – the market for insurance looks to be getting harder, with pricing ticking up. That big gust of wind that just went by? Nope, not a hurricane remnant, but a sigh of relief coming from Liberty Mutual, Chartis, Hartford, and the Travelers…
Now that this is put to rest, we can all hit the sack, secure in the knowledge that here, in (YOUR HOME TOWN), we are safe and sound, protected by misinformation by these diligent pursuers of the truth. Or at least their version of it.
cheers!

This fortnight’s edition of Health Wonk Review is ably hosted by Joe Collucci of the New America Foundation – just like the muppets, it is short and sweet.

long time HWR host David Williams is the brains behind this week’s edition. lots of good info relayed concisely.
thanks David!

It’s August. Things are supposed to be slowing down, as record heat waves hit the south central part of the nation, vacations thin out offices and shorten commuting times, and parents rejoice that their beloved offspring – and their detritus – will soon be somewhere else most of the time.

(photo from illinois.edu)
But in health policy world, the pace just picked up – a lot. Far from the summer doldrums, activity related to the debt limit, IPAB, Medicare reform and Health Exchanges is at a late-September pace.
To start us off, here are four posts focused on the recent stupidity around the debt limit expansion, and the impact of that stupidity, that merit top-of-the-fold placement.
WARNING
here’s a picture of a health care exec before reading the following two posts….

First, let’s ruin your day with the scariest post of the summer (if not the year) from Bob Laszewski. Bob’s view of the debt limit deal will ruin the vacation of any provider:
“Physicians, facing a 29.5% Medicare Sustainable Growth Rate (SGR) fee schedule cut on January 1, 2012, need to be really worried. That 29.5% cut is part of the existing budget baseline from which the super-committee needs to cut hundreds of billions more–much less find tens of billions of dollars to put these doc cuts off again. Hospitals … have to be in the bull’s eye this time. Drug companies are a particularly juicy target for liberals who don’t like them and conservatives who wish the Part D program had never been passed. Medicare Advantage insurers have recently been reporting record profits–not something you want to be doing when the Congress is looking for lots of cash.
While there is a 2% cap on any cuts that could occur to Medicare in the $1.2 trillion default trigger, there are no limits to what the super-committee can cut.” [emphasis added]
My view is there are going to be big cuts in provider reimbursement, which will inevitably lead to cost-shifting to private payers. That means insurers, healthplans, self-insured employers, and workers comp payers can expect higher pricing and utilization, and soon.
And here they are after reading those posts…

The prolific Maggie Mahar has posted a thorough and well-documented piece on the whole debacle, citing Paul Volcker among others to note this should have been a routine process – after all, ” George W. Bush raised the debt ceiling seven times for a total increase of 90 percent. Ronald Reagan raised the debt ceiling 18 times for a total increase of 199 percent, which is the highest ever percentage increase in U.S. history. So far President Obama has raised the debt ceiling three times for a total increase of 26 percent.”
Maggie quotes the AP on the potential (I think highly likely) that “payments to doctors, nursing homes and other Medicare providers could be trimmed, as could subsidies to insurance companies that offer an alternative to government-run Medicare.”
Finally, Jaan Sidorov educates us on the relationship between US Treasury ratings and health insurers, noting “With an announcement of a downgrade, millions of dollars of insurer money in reserves and surplus could evaporate.”
Gotta love David Williams’ post Health care reform in 2 short sentences. Read it.
Absent any game-changer along the lines of David’s, we’re going to have to rely on science and smart policy – which means the Independent Payment Advisory Board. Jonathan Cohn’s post at Care and Cost makes a compelling argument to not repeal, but rather retain, if not strengthen, IPAB. Jonathan notes “there’s a ton of data to suggest it [Medicare] doesn’t do a very effective job of fostering good quality”.
Which leads us to Avik Roy who contributes a post citing Cato’s Michael Cannon’s research to make the point that politicians don’t care about waste fraud and abuse in Medicare and Medicaid because it’s other people’s money. He must be talking about the GOP, as much of the ‘waste and fraud’ could have been eliminated if the GOP-led Congress and Republican President hadn’t: a) passed and signed the Medicare Modernization Act which prohibited CMS from varying payment based on efficacy of drugs and devices; b) continued the gutting of Federal outcomes research; c) passed Medicare Part D while prohibiting CMS from negotiating drug prices with pharma; and d) suspended Pay-as-You-Go rules that would have required cuts in other programs to offset the huge cost increases from these programs.
Oh, and many are now looking to kill IPAB, which promises to reduce unnecessary and wasteful spending…
Sticking with cost control, our buddy Hank Stern thinks the Institute of Medicine’s support for coverage of birth control pills at no cost to women may lead us down a slippery slope – if birth control pills are “medically necessary’, what about Rogaine?
Health Affairs contributed a thoughtful and compelling piece on the impact of ACA on employer health insurance, focusing on the McKinsey study’s conclusion that lots of employers will drop health insurance. Authored by the redoubtable Jeff Goldsmith, the post makes compelling reading. Among the more thought-provoking passages are these:
– “the large employer’s influence on benefit design has been a major enabler of escalating premiums. The main influence hasn’t been first dollar coverage, but rather their preference for open access, point-of-service plans…”
– “A surprisingly large percentage of the survey’s respondents were not aware of many specific features of the legislation that will directly affect them.”
– “it doesn’t make sense, for small employers or their workers, for small employers to continue offering coverage given these incentives.”
Health Access California’s Anthony Wright digs deep into the Exchange issue. If Jeff Goldsmith’s prognostications are right – and they may well be – the Exchanges will soon be the dominant channel for insurance distribution. Anthony’s point that “health reform cannot fulfill its promise if the Exchange is not successful” is the core of his contribution, which provides a thorough and succinct summary of what Exchanges should be.
The ever-insightful Louise at Colorado Health Insurance Insider’s got a great piece on her state’s efforts to create an unbiased Health Exchange. As an independent insurance broker, her views are reality-based and observations are keen.
John Goodman’s contribution is entitled “Everything We Are Doing in Health Policy May Be Completely Wrong”. Goodman comes to this from his review of a study focused on a change in the maximum one-time supply of drugs in North Carolina’s Medicaid program from 100 days to 34 days. Goodman posits this: “Suppose that for most poor people and most health care, time is a bigger deterrent than money.” The study isn’t available without purchase, so I wasn’t able to find out what it actually said.
WorkCompInsider’s Julie Ferguson, the progenitor of many work comp-related blogs and social media initiatives, gives comp folks a solid background on the use of social media to investigate work comp fraud, along with a treasure trove of links to sources, views, and legal advice.
Long-term contributor Roy Poses never relents in his pursuit of ethical issues in health care; his contribution for this edition is a two-part series on the for-profit hospice industry.
Roy cites a Bloomberg report suggesting that (here and here) for-profit hospices may increase revenue by aggressively recruiting patients, sometimes using deception, and sometimes including those who are not really terminally ill. However, they may then deny the latter group potentially life-saving care (because hospices are supposed to only provide palliation and improve quality of life for dying patients.) This suggests that hospices may function like real “death panels.” Yet those who have ranted about the dangers of government “death panels” have not yet shown any concern with this.
That’s not to say that health care professionals shouldn’t pay close attention to the financials – a point Brad Flansbaum makes quite compellingly in his post on the impact of medicare rates, private payers, and their impact on hospitalists.
Kirstin Siemering sends us news of a company in Nebraska that’s really, truly, totally committed to improving their employees health and wellbeing – and seeing huge returns in lower health costs, increased productivity, and higher quality.
From Amy Berman comes a cold blast of reality – she’s been diagnosed with Stage IV breast cancer which has metastasized to her spine. Amy discusses a real and ongoing problem, one that greatly affects people and costs – the inability of many care givers to frankly discuss the reality of terminal illness with patients, and the resulting heroic efforts that cost billions while providing little, if any, benefit to the vast majority of patients.
Jessie Gruman’s post gets the award for best title – Our Preference in Health News: Uncertainty or Naked Ladies? Jessie identifies the issue – we want quick, we want certain, we want easy – and no, we don’t want to think. Err, I mean the folks who DON”T read HWR!
Jessie and Gary Schwitzer must’ve been experiencing the same frustration: Gary’s contribution is a video summary of his experience reporting on health journalism, the first of his five-part series that should be must-watch for any health care journalist.
The post from Glenn Laffel’s Pizaazz focuses on the impact health news/journalism can have on the patient, along with many patients’ lack of basic computer, internet, and interpretive skills – skills many of us take for granted.
Kinda/sorta related is the post from Shahid Shah; who explains what the FDA’s new draft guidance on mobile apps means to health IT vendors. It’s a great summary of what kinds of apps may or may not be considered medical devices from a regulatory perspective and is worth reading if you’re in the mHealth space.”
And now, for something completely different, we offer Jason Shafrin’s post on Brazil’s health care system.
That’s it. I’m off for a few days to Oklahoma City (what, that’s not a common vacation spot?) next week, then a family vacation to Block Island. Hope your August is good – although I’m likely partially to blame if it isn’t!

Julie Ferguson has posted the The Heatwave Edition of Health Wonk Review at Workers’ Comp Insider – it’s the only issue this July, so it’s chock full of wonkery. Check it out.

This week Tinker Ready is hosting HWR; the proud Bruins and Springsteen fan adds her usually distinctive touch to this biweek’s edition.
I add my congratulations to the Bs and sadness at the departure of Clarence Clemons – play a bit of Jungleland and you’ll know why.

Our colleagues at Health Affairs have the honor of hosting this edition of HWR. Lots of great insights into the Medicare Trustees report, the growing body of work explaining the impact of health reform, and what states and employers are doing to control costs and improve quality.