December 03, 2013
The October jobs report from the Bureau of Labor Statistics showed unemployment inching up from 7.2 percent in the September report to 7.3 percent today. That, however, wasn’t the most significant concern emerging from those numbers.
The healthcare industry added about 15,000 jobs in October, slightly lower than 17,000 jobs-per-month average we’ve seen so far this year and significantly below the average monthly increase of 27,000 in 2012.
Yes, healthcare is still proving to be a vital job-creating engine for our nation’s economy, but the concern at hand is whether job growth in the various health professions will keep pace with escalating demands caused by Affordable Care Act health exchange enrollments, Medicaid expansion and the aging of the U.S. population.
There has been a great deal written about our society’s increasing need for doctors as health services utilization stays on an upward trend, but it’s not just physicians. The current and potential healthcare workforce shortages extend to all parts of the workforce, from nurses to pharmacists to researchers.
The multi-sector membership of the Healthcare Leadership Council is actively engaged on this issue.
During meetings with members of Congress and congressional candidates, HLC has consistently emphasized workforce shortages and the corresponding need for more interest and participation in science, technology, engineering and math (STEM) education; realignment of incentives to encourage more integrated, coordinated team care; and adequate payments for hospitals, clinics, doctors, laboratories and other providers.
This month, we will be bringing together representatives from our member companies and organizations for in-depth discussions on how multiple sectors can bring their particular insights to this challenge and to focus on the public policy steps that could help alleviate the healthcare workforce shortages – shortages that are likely to be exacerbated in the very immediate future.
November 26, 2013
With U.S. Senate Democrats exercising the so-called ‘nuclear option’ – changing Senate rules so that executive branch nominations can be approved by a simple 51-vote majority instead of the 60 votes needed to overcome a filibuster – there has been speculation about what this means for the Independent Payment Advisory Board (IPAB).
IPAB, as health policy aficionados know, is the 15-member board of political appointees created by the Affordable Care Act that has unprecedented powers over Medicare spending. To summarize IPAB in a nutshell, if Medicare spending exceeds an arbitrary level set by law, IPAB board members will offer recommendations on how to cut outlays. If Congress doesn’t achieve a supermajority in favor of an alternative approach, or doesn’t act at all, the IPAB recommendations automatically take effect.
HLC and hundreds of other patient and healthcare provider groups oppose this concept for a number of reasons, including the likelihood it would result in arbitrary reimbursement cuts that would undermine healthcare quality, accessibility and value as well as the fact it gives an unelected, unaccountable board powers constitutionally assigned to elected members of Congress.
IPAB’s controversial nature meant that it would be extremely difficult for the White House to successfully appoint board members – that is, if the Senate still had a 60-vote threshold for confirmations. Now that the ‘nuclear option’ has been invoked, some reports have said this is good news for an Administration that no longer needs Republican votes to fill the IPAB vacancies.
The fact is, though, that this is something of a non-issue.
As the Cato Institute’s Michael Cannon explained quite well in Forbes, the IPAB provisions in the Affordable Care Act make provisions for the eventuality that the President doesn’t nominate or the Senate doesn’t confirm board members. If that occurs, all of the powers granted to IPAB automatically transfer to the Secretary of Health and Human Services. If that happens, significant powers to control Medicare spending would have transferred from the legislative branch to the executive – definitely not what our Founding Fathers intended.
All this is to say that the only way to keep Medicare beneficiaries from being harmed by IPAB is to repeal it altogether, something both Democrats and Republicans in both houses have indicated they want to do.
November 21, 2013
There is more good news on the healthcare cost front. The White House Council of Economic Advisers has issued a report noting that real per capita healthcare spending has increased in this decade at an average annual rate of just 1.3 percent. This lower spending rate – which encompasses Medicare, Medicaid and private health insurance – represents the lowest healthcare price inflation rate in 50 years.
(Reasonable people will have differences on the reasons for this cost containment success. The White House, understandably, wants to give ample credit to the Affordable Care Act. Some say it’s a result of the nation’s economic stagnation. I would argue that innovations in many healthcare sectors – documented in detail here – are providing patients and consumers with higher quality at less cost.)
This continuing trend regarding healthcare costs deserves special attention as a special joint congressional committee negotiates budgetary issues. There is a desire among many lawmakers to do away with all or part of the budget sequester and replace it with targeted cuts. The data we’re seeing from the White House and other sources underscores that there is no compelling reason to target healthcare programs for arbitrary reductions, cuts that could have an adverse impact on access, quality and innovation and undo many of the successes we’re seeing in containing long-term cost escalation.
Instead, if Congress is looking for some possible pools of money to replace sequester cuts, a good idea might be hiring the Pentagon some better accountants to see what the military is getting for trillions of dollars in spending that has, according to a Reuters investigation, never been sufficiently audited. Just a thought.
November 01, 2013
The Pennsylvania state legislature has passed a medical liability measure that doesn’t make malpractice lawsuits more or less difficult or affect the level of damages a plaintiff may receive, but it does take a meaningful step forward in support of compassion and basic humanity.
Pennsylvania lawmakers adopted what they call “benevolent gesture” legislation. Essentially, it corrects one of the deplorable side effects of today’s medical liability environment. The bill allows doctors to communicate to patients’ loved ones as human beings.
The fact is, even if a physician does everything right and according to evidence-based protocols, unfortunate outcomes happen. But, in today’s environment, doctors are unable to express sympathy or concern to patients’ families for fear that those words can be used against them in a courtroom. Simply saying ‘I’m sorry’ for a family’s loss can be misinterpreted as an admission of malpractice.
Thus, patients’ loved ones find themselves angry at doctors who they view as uncaring, simply because of this invisible wall between them that is created by possible litigation.
The Pennsylvania law simply states that healthcare providers can express words of condolence, compassion or commiseration without those sympathetic thoughts being considered admissible evidence in any future legal actions. Without constraining in any way the right to sue, this legislation at least allows physicians and patients’ loved ones to act like people instead of potential courtroom combatants.
October 16, 2013
Right now, I’m attending the annual Cleveland Clinic Innovation Summit, which is focused this year on obesity, diabetes and the metabolic crisis. Speakers have addressed in detail the linkage between body weight and the chronic diseases – diabetes, heart disease, cancer – that are the leading drivers of healthcare cost increases.
While these important discussions are taking place in Cleveland, an important development on this front was presented to the public on the pages of the American Journal of Medicine. A study by the Baylor School of Medicine (Baylor is a Healthcare Leadership Council member) presented clear evidence on how individuals can more effectively lose weight.
The study found that people enrolled in community-based weight loss programs offered by Weight Watchers (also a Healthcare Leadership Council member) were much more successful in shedding pounds than those who took a do-it-yourself approach. Among the findings:
• At six months, the test group assigned to the Weight Watchers program lost an average of 10.1 pounds. Those who were sent home with dietary and exercise self-help materials lost an average of 1.3 pounds.
• Those who engaged in Weight Watchers were eight times more likely to achieve at least a five percent weight loss than those doing it on their own.
• Participants who engaged with Weight Watchers through all three available avenues – in-person meetings, mobile applications and online tools – experienced the greatest weight loss.
This is a significant study, particularly given our national imperative to achieve a greater degree of population wellness. We now have compelling evidence that weight loss is more effectively achieved when individuals can utilize the expertise provided by an organization like Weight Watchers and when there is a social support mechanism to the weight loss effort.
Or, as Weight Watchers co-chief scientific officer Karen Miller-Kovach, MS, RD, put it, “Multiple access routes to engage with a proven weight loss approach make a measurable difference.”