Weekend update / Miscellany

  • It occurs to me that the belated federal benefits enrollment period finally ended yesterday.
  • The President issued several executive orders on Friday that reversed several Bush administration positions on government contracting. The Washington Post reported the Washington Post reports that these orders

    Require federal [service] contractors to offer jobs to current workers when contracts change.
    Reverse a Bush order requiring federal contractors to post notice that workers can limit financial support of unions serving as their exclusive bargaining representatives. [FEHBlog note — this is Section 5.61 of the current OPM standard contract]
    Prevent federal contractors from being reimbursed for expenses meant to influence workers deciding whether to form a union and engage in collective bargaining.

    Govexec.com reports that the NTEU and AFGE are pleased by these developments.

  • You may recall that in May 2006, a laptop computer and external hard drive containing the personal information of millions of veterans was stolen from a VA employee’s home in Montgomery County, MD. The police later found the laptop and tests indicated that the personal information was not wrongly used, and the VA provided credit counselling. Nevertheless, a lawsuit ensued, and the AP reported last week that the VA has agreed to pay $20 million to settle the lawsuit, subject to judicial approval. According to the AP,

    The money, which will come from the U.S. Treasury, will be used to pay veterans who can show they suffered actual harm, such as physical symptoms of emotional distress or expenses incurred for credit monitoring [and of course their lawyers].

  • The New York Times reported yesterday that the healthcare industry could benefit from “disruptive innovation.”

    Disruptive innovators in health care aim to shape a new system that provides a continuum of care focused on each individual patient’s needs, instead of focusing on crises. Mr. Christensen and his co-authors argue that by putting the financial interests of hospitals and doctors at the center, the current system gives routine illnesses with proven therapies the same intensive and costly specialized care that more complicated cases require.

    The article describes Kaiser Permanente, a group model HMO, as a successful integrated mode. The article quotes managed care maven Uwe Reinhardt

    “It is much cheaper than pay-for-service systems, because they have absolutely no incentive to overtreat you, but they have every incentive to keep you healthy,” he says. “Kaiser still makes mistakes — any large system does — but their facilities always come out ahead in every service quality survey I’ve reviewed.”

    Of course Kaiser Permanente has been around for over sixty years. According to Kaiser’s Fast Facts website, it has brought the following innovations to U.S. health care are:

  • prepaid insurance which spreads the cost to make it more affordable
  • physician group practice to maximize their abilities to care for patients
  • a focus on preventing illness as much as on caring for the sick
  • an organized delivery system, putting as many services as possible under one roof
  • Kaiser has an interesting approach but it’s not for everyone (at least pending Medicare for All). The Wall Street Journal reports that CMS and commercial health plans are considering adopting a middle ground of paying doctors for episodes of care similar to Medicare’s hospital diagnosis related group payments — as opposed to a fee for service basis. The Bridges toExcellence group advocates this approach, but the medical community is concerned. According to the Journal,

    “It’s hugely worrisome to us,” said Lawrence Martinelli, an infectious-disease specialist in private practice in Lubbock, Texas. “There’s concern about not only how much you’re going to get paid, but whether you can negotiate a contract where you can at least break even.”

    “Ay, there’s the rub.” (hey, I’m quoting Shakespeare here.)