Tag Archives: hospitals

How Hospitals Coddle the Rich

When I saw my first red blanket as a young medical student, I thought little of it.

One morning, as I rushed around a hospital in California on my daily rounds, I spotted an old man who lay in bed beneath a scarlet cover, a sharp contrast to the white linens wrapped around the other patients. He looked unremarkable, and I assumed he brought the blanket from home. So I moved on. He wasn’t my patient, anyway

That afternoon, I overheard a discussion about the patient between two physicians. Instead of identifying him in the usual manner — age, gender, medical problems — one of the doctors said, “This is a red blanket patient.”

The significance became clear after I took care of my own red blanket patients: It was a marker of status. At that hospital, patient relations gave them to some C.E.O.s, celebrities and trustees’ friends. Although we weren’t instructed on how to treat the V.I.P. patients, the blanket spoke for itself: “This patient is important.”

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary


Medicare Patients Are in for a Surprise

Imagine you’re a Medicare patient, and you go to your doctor for an ultrasound of your heart one month. Medicare pays your doctor’s office $189, and you pay about 20 percent of that bill as a co-payment.

Then, the next month, your doctor’s practice has been bought by the local hospital. You go to the same building and get the same test from the same doctor, but suddenly the price has shot up to $453, as has your share of the bill.

Patients around the country are getting that unpleasant surprise, as more and more doctors’ offices are being bought by hospitals. Medicare, the government health insurance program for those 65 and over or the disabled, pays one price to independent doctors and another to doctors who work for large health systems — even if they are performing the exact same service in the exact same place.

This week, the Obama administration recommended a change to eliminate much of that gap. Despite expected protests from hospitals and doctors, the idea has a chance of being adopted because it would yield huge savings for Medicare and patients.

In the dry language of the annual budget, the White House asks Congress to “encourage efficient care by improving incentives to provide care in the most appropriate ambulatory setting.” In normal English, that means reducing financial incentives that are causing many doctors to sell their practices to hospitals just to take advantage of extra revenue.

The heart doctors are a great example. In 2009, the federal government cut back on what it paid to cardiologists in private practice who offered certain tests to their patients. Medicare determined that the tests, which made up about 30 percent of a typical cardiologist’s revenue, cost more than was justified, and there was evidence that some doctors were overusing them. Suddenly, Medicare paid about a third less than it had before.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

The Skinny on Narrow Health Care Networks

Lots of people shopping in the new health care marketplaces this year picked health plans that limited their choice of doctors and hospitals. The plans were popular because they tended to cost less than more conventional plans that covered nearly every health care provider in a region.

The proliferation of these more limited plans, called narrow networks, has worried consumer advocates and insurance regulators. The concern is that people will struggle to find the care they need if their choices are limited.

Maybe we don’t have to worry so much. A new study suggests that, done right, a narrow network can succeed in saving money and helping certain patients get appropriate health care. The study, published as a working paper with the National Bureau of Economic Research, looked at a program that used financial incentives to steer workers into narrow plans. Those that chose the plans saved their employer money, saw their primary care doctors more and used the emergency room less. That doesn’t mean that narrow networks are the right choice for every health care consumer, but it all sounds like good news for the type of patient who wants such a plan. Done right, a smaller choice of doctors may have some advantages.

What’s encouraging about the program, studied by the economists Jonathan Gruber of M.I.T. and Robin McKnight of Wellesley College, is that its conditions look similar to what we’re seeing in the marketplaces. Massachusetts offered its workers a discount — three months premium-free — if they chose a narrow network plan over a standard offering. Only about 10 percent of the workers took the state up on the offer. Over the course of a year, that group’s health care cost its employer 36 percent less than it cost to cover their colleagues in the traditional plans. Over all, that translated to a 4.2 percent decrease in spending for the whole program.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

New York to Create Medical Record Highway

In a much-anticipated move, the New York state Legislature recently agreed to spend $55 million to create a statewide digital highway for New Yorkers’ medical records.

Known as the State Health Information Network of New York, and called “Shiny” for its acronym, SHIN-NY, the project will connect millions of patients, thousands of doctors and scores of health care systems in New York state.

A completed network will also be a boon to dozens of small businesses, including biotech startups—both through directly creating jobs related to building the network, and opportunities that will come with access to a new big data mine.

Health systems and hospitals will be among the first to benefit from SHIN-NY. They’ve already spent tons of money on computerizing health records, and are under federal pressure to continue doing so.

“Hospitals have made investments in health-information technology,” said Zeynep Sumer, vice president of regulatory and professional affairs for the Greater New York Hospital Association, a trade group. For now, access to that data is available only within local networks. There are currently 10 such systems, known as Regional Health Information Organizations, or RHIOs.

Economic engine

Completing the network will mean that these regional systems will be able to talk to each other. That will allow hospitals “to securely communicate important clinical information with a patient’s entire care team,” Ms. Sumer said.
A less-noticed benefit is that its completion will give scores of small businesses an economic boost.

One such company is Mana Health, a startup near Times Square whose co-founder and chief executive, Chris Bradley, won a state competition to design the best patient portal for SHIN-NY, followed in August by a contract.

Mana Health’s software for the portal is due to be tested when the program is rolled out in June, though Mr. Bradley said, “I’m not at liberty to discuss contractual details.”

At the New York eHealth Collaborative, a nonprofit that will oversee the network, Chief Executive David Whitlinger said completing SHIN-NY will create about 160 jobs in New York City, many at the existing regional organizations. They will need more software developers, clinical specialists, project managers, and sales and marketing representatives.

“Each of the RHIOs is essentially a small business,” he said.

To read more, click here.

Jeffrey R. Ungvary


Jeffrey R. Ungvary