As I read your final blog and also read the posts that others wrote on your blogs, please take some time to reply to their comments and questions. It's not a grade, per se, but given all the work you put in to your blog and final blog, it is a good way to learn from what others posted and have a chance to respond.
So please, after you are done with the final, take a minute to read others' comments.
Thank you all for great work on your blogs, and for your comments.
The Obama administration and congressional Republicans and Democrats took added steps in 2015 that potentially could discourage overbilling and other fraudulent activities by changing the way doctors are reimbursed for their services. The Medicare Access and CHIP Reauthorization Act (MACRA) was designed to shift the medical system away from tradition “fee-for-service” and towards rewarding the quality of service in a bid to save hundreds of billions in the coming decades. But while the Obama administration took an important step last October by issuing the proposed new regulations to implement the law, they could be stopped in their tracks under the new Republican leadership at HHS.
Surprised? My guess is that an executive action cannot stop this, but who knows.
As of today, May 1, Northwest Healthcare is no longer in UnitedHealthcare's network - a contract termination that will affect thousands of Tucson area patients. As has been the case throughout the dispute, each side had its own version of what happened.
The end of the contract means patients covered by UnitedHealthcare will no longer be able to use Northwest Medical Center and Oro Valley Hospital, except for emergencies. They will also no longer be able to have visits to Northwest Allied Physicians and Northwest Healthcare urgent care centers, among others, covered by their insurance.
A contract termination affects UnitedHealthcare’s Medicaid, Medicare Advantage, individual and employer-sponsored plans (but not MediGap plans). UnitedHealth officials last week said they already had a transition-of-care plan in case the contract wasn't resolved.
Both sides of the dispute have written newspaper op-eds, as well as letters to patients (see below). Northwest Healthcare said it sent out more than 60,000 letters to UnitedHealthcare patients who had used a Northwest facility in the last year. It also set up a website called Stand Up to United Az.
Some Background
According to an opinion in the local paper, the CEO of Arizona Health Plans of United Healthcare, Dave Allazetta, claimed that
UnitedHealthcare wants nothing more than to continue our relationship with Northwest. In fact, we are offering to reward Northwest [Hospital] for the important services it provides to our members in Southern Arizona if the health-care system will commit to a value-based care model. Simply stated, value-based care means a portion of the health-care system’s payments from UnitedHealthcare would be based on how it performs against key quality measures and improved health outcomes for its patients.
It might be worth investigating what United Healthcare means by "a value-based care model." But obviously it seems much more complex than what is offered by United Healthcare. Given that Northwest Healthcare is owned by Tennessee-based Community Health Systems, it ultimately came down to them.
For those of you who will be here and are interested in the intersection of Cyber and medicine, the University of Arizona College of Medicine-Phoenix and the Atlantic Council are hosting the CyberMed Summit on Thursday, June 8 and Friday, June 9, 2017 at the University of Arizona in Phoenix. This first-of-its-kind simulated clinical cyber crisis exercise and discussion summit will feature notable voices in clinical medicine, security research, medical device manufacturing, and public policy. For more information see http://cybermedsummit.com and to RSVP, contact Anni Piiparinen of the Atlantic Council at apiiparinen@atlanticcouncil.org or 202-292-5164.
In addition to the readings on Doctor's Don't Listen, another reading from last Wednesday was on The Patient's Playbook. Here is a short (2 min) video from the CEO, Leslie Michelson.
Here is a quote from the article (linked):
Getting a scary diagnosis can be emotionally overwhelming. While it’s not always easy, the best approach is to summon the courage to ask tough questions, do more research on your condition, and get additional expert opinions. It’s essential to do this before before agreeing to powerful therapies or surgeries, as diagnostic error isn’t just inconvenient and frustrating: When you are misdiagnosed, you run the risk of receiving unnecessary and potentially harmful treatments.
Here are 8 essential questions to ask your doctor about a diagnosis. You should supplement them with questions that are relevant to your specific circumstances.
I understand that you believe I have this disease, but how confident are you in the diagnosis?
Is there anything else could this be?
Are there more tests that can be done to confirm this diagnosis?
Was the lab test sample good/the imaging clear? Would it make sense to get a second read?
Have you read all my medical records to get the full picture of my symptoms? Would it help if I went over them with you?
You say I have an abnormal blood test/a lab abnormality and that we can treat it with medication. But is it possible that this is indicative of a bigger problem? Are there other tests we should be doing to rule out serious diseases?
Before we move forward with treatment, are you confident we’ve explored all my options?
I appreciate what you’re saying, and it sounds very serious. I’d like to get copies of my lab reports/imaging/medical records in order to get a second opinion.
Here is a link to the book, Patient's Playbook. You can read more about this. After the 8 essential questions, I clicked on Toss Your Diet Books! Good Health Comes Down to 5 Simple Steps. There is a PBS video on "In Defense of Food" by investigative journalist Michael Pollan There's even a documentary about it (trailers shown below on this page - scroll down).
I saw this last year (Oct. 2016), and maybe you did, too. The language is explicit, and views of addicts and what they do to get their drugs. But it's relevant to our earlier conversation. He interjects his strange humor as he gets to the main points, which are important, especially Purdue's marketing of OxyContin.
Here is a series of articles related to our topic this week. Rather than add it to our readings, I thought we could comment here. Click on the author and Gazette-Mail link for access to the three articles. I'll post some thoughts below. But you can do the same.
Mr. Eyre (pronounced AIR), 51, won the award for a series of articles about the opioid abuse epidemic in West Virginia. Mr. Eyre, the paper’s statehouse reporter, began his multipart series with these words: “Follow the pills and you’ll find the overdose deaths.” It took Mr. Eyre years to acquire the documents most important to his reporting, and he did it “in the face of powerful opposition,” according to the Pulitzer citation. A lawyer defending a drug wholesale company said that it was vital to protect crucial court records “from the intrusive journalistic nose of the Gazette-Mail.”
From the first article, it's about collusion of the nation's largest drug wholesalers flooding notorious “pill mill” pharmacies in West Virginia's smallest towns and poorest counties with hundreds of thousands of painkillers, according to court records the companies had sought to keep secret for more than a year. Moreover,
West Virginia has the highest drug overdose death rate in the nation, and the deaths are climbing. Oxycodone and hydrocodone are the most widely abused prescription painkillers, and contribute to more overdose deaths in the state than any other drug. West Virginia spends more than $430 million a year on problems caused by prescription drug abuse, according to the state's lawsuit.
The series uncovered how small towns of 392 people were devastated from opioid overdoses. Look at the data, read the series, and comment.
