US primary care needs help

The Commonwealth Fund released a study comparing primary care in the United States to other industrialized countries. Primary care needs help. US healthcare needs help. Solving our problems in primary care will go a long way to fixing healthcare. The facts from the study are compelling:

Percent of Patients Seeing the Same PCP Greater Than 5 Years:

o   US 43%

o   Germany 71%

Percent of PCPs that Perform House Calls:

o   US 37%

o   UK 97%

Percent of PCPs that Offer After Hours Access to Patients:

o   US 45%

o   Germany 96%

Percent of Primary Care Practices that Offer Mental Health Services, too:

o   US 33%

o   Sweden/Netherlands 94%

The Commonwealth Fund study offers several recommendations for the US to improve Primary Care, most of which involve paying primary care physicians MORE and paying them differently.

Hopefully the new administration embraces fixing primary care.

United Healthcare defends itself?

CEO Andrew Witty issued United Healthcare's first official response to the recent outpouring of public criticism of the insurer's practices.

The gist of his comments focused on blaming hospitals and drug companies for the rising cost of healthcare. In one specific quote Witty states:"Fundamentally, healthcare costs more in the U.S. because the price of a single procedure, visit, or prescription is higher here than it is in other countries. […] The core fact is that price, more than utilization, drives system costs higher.”

Witty took an indirect shot at hospitals, saying there are “participants in the system who benefit” from higher prices even as others work to fix the problem. He said patients would benefit from cheaper sites of care, but that threatens revenue streams for organizations that depend on charging more for care!

That is a reference to longstanding efforts in Congress, fiercely opposed by hospitals, to equalize Medicare payment for certain services provided at hospital outpatient departments with those provided in physician offices.

These criticisms of hospitals illustrate Witty's fundamental misunderstanding of the health system's dependence on the flawed cross subsidization system - because it drives healthcare's problems. Witty's focus on hospital prices is misguided.

Hospital payments have little to do with prices. For example, Medicare and Medicaid account for 70-80 percent of hospital payments. Those payments are regulatory and have nothing to do with hospital prices. These government payments pay hospitals less than costs. The most recent American Hospital Association studies indicate that government payments only cover 80 percent of hospital costs. So private insurers do pay higher prices to cross subsidize these inadequate government payments. The bottom line is that hospital profits are very modest while United Health’s profits are robust and increasing.

In fact, United is exacerbating the cross-subsidization problem by paying hospitals less than Medicare for United Medicare patients.

The article also discusses the fact that United Healthcare’s medical loss ratio is increasing - which supposedly means United is making less profit. However, one way United increases the medical loss ratio is by acquiring physician practices. They make money off physician practices and use the cost of those practices to raise their medical loss ratio.

Finally, United asserts that their Medicare Advantage plans are good for consumers. The truth is Medicare advantage plans cost Medicare 108 percent of traditional Medicare - costing taxpayers billion. At the same time United aggressively limits patient choices for care and routinely denies coverage.

United Health’s defense of its operations leaves much to be desired.

Thoughts on the murder of United Healthcare's CEO

This editorial opinion by the Wall Street Journal regarding the murder of United Healthcare CEO Brian Thompson misses the point. The murder of this CEO was not justified. However, the anger of US citizens about a dysfunctional health system is justified.

This opinion seems to make numerous excuses for private insurers and blames Congress. Both parties are guilty. The opinion recites a litany of problems in healthcare without suggesting that someone is responsible for the US health system. The real issue this opinion ignores is that Americans have reached a breaking point—the abuses of the healthcare system on patients and caregivers have pushed people over the edge. The outpouring of arguments over healthcare injustices and the lack of serious solutions is why someone was compelled to make a statement for society by murdering a CEO.

Wake up Congress and healthcare leadership - significant changes to the health system are needed quickly.

Solutions start with simplification and a single payment model that rewards the correct behavior. Today’s payment model, based on a highly complex coding system, actually discourages doctors from talking with patients and each other. It encourages fraud and abuse with a complicated coding system that no matter how many regulations we add encourages bad behavior.

We need to focus on simple solutions that encourage good patient care, not denials. Go to www.thejourneys-end.org for some practical solutions.