The Medicine Bag NewsOK.com Blogging Community

After taking a hiatus from The Medicine Bag, I have returned … with a question.

Do you think it’s fair and/or accurate to see Oklahoma ranked at or near the bottom of, well, just about every study of health that comes our way? We can’t be worst in everything health-related, can we?

I say this after reading about Wednesday’s report from The Commonwealth Fund. The nonprofit ranked children’s health in states on 13 indicators that included access to and quality of care, outcomes, equity and cost.

Oklahoma pulled up the rear. Fifty-first. Behind the District of Columbia and Mississippi. Leading the rankings were Iowa, Vermont, Maine, Massachusetts and New Hampshire.

Now, I know the devil’s in the details, and I admit I haven’t looked at the methodology of this report. I usually do, however, which is why I ask about the fairness of all this. I imagine this report would pass muster if you agree what it measures accurately sums up the state of children’s health.

Ah, here’s where it gets tricky: Are the measures used fair? Are small differences in rates or percentages blown out of proportion? Is the information current, or as current as possible?

See the state’s “scorecard” for yourself here.

The interesting thing about these reports is they are all largely slicing and dicing the same data. Sometimes it gets hard to tell them apart.

Anyone who honestly assesses the state’s health will find huge problems. But last or near-last every time? Perhaps I’m becoming desensitized, but my reaction is getting to be “C’mon!?!”

What’s yours? Tell me what you think by posting a comment on this blog.

Jeff Raymond, Medical Writer

 Is retirement going to be a luxury for thirty- and forty- something workers? I increasingly think it will be, and a new estimate from investment giant Fidelity does nothing to dispel that.

A 65-year-old-couple retiring this year will need approximately $225K to cover medical costs in retirement, Fidelity estimates. Let’s not lose sight of the fact that this is in addition to the coverage available under Medicare, which may itself not be available when I and others retire.

The hypothetical retirees will still have to have enough money to live, either independently or in long-term care.

Perhaps what’s even more sobering than the estimate is its growth since 2002 — 41 percent.

The roughly 6 percent annual growth in the Fidelity projection about matches the growth of my 401K fund during a slow year. I know that doesn’t take into account contribution matching and interest compounding, but I think it raises a worthwhile point nonetheless.

And health care costs show no signs of flattening or decreasing.

Does paying for retirement terrify you as much as it terrifies me? Leave me a comment at http://blog.newsok.com/health.

Fidelity recommends:

- Creating an individual retirement plan

- Starting early and maximizing opportunities to save

- Assessing health status and becoming a smarter consumer of health care

- Determining details of any employer-sponsored coverage

- Understanding the financial impact of health care costs on Social Security income

Jeff Raymond, Medical Writer

Emergency room payments declined over an 8-year period, with Medicaid paying less overall than do uninsured patients, a recent study in the Annals of Emergency Medicine reported.

In a news release, researcher Dr. Renee Hsia of the University of California at San Francisco said the “falling reimbursements” were a “consistent trend” over the study period.

“What surprised us was that uninsured patients actually pay a higher proportion of their emergency department charges than Medicaid does,” she said.

According to the release, 35 percent of charges for uninsured visits were paid in 2004, compared to 33 percent for Medicaid visits.

Researchers studied charges and payments for 43,128 emergency department visits from 1996-2004. Nationally, the overall proportion of charges paid for outpatient emergency room visits declined from 57 percent to 42 percent.

“Declining reimbursement ratios will cut into the ability of emergency departments to recover their actual costs of providing care,” Hsia said.

Jeff Raymond, Medical Writer

When the Centers for Medicare and Medicaid in August announced it wouldn’t pay for hospital mistakes and infections, I expected discussion and debate.

Today’s issue of The New England Journal of Medicine delivered as promised. In it, Meredith Rosenthal, an associate professor of health economics and policy at the Harvard School of Public Health, provided a good, balanced overview of the change’s likely effects.

The rule change, she noted, implemented a congressionally mandated change in hospital reimbursement. It makes the agency’s payment policies “far less passive” than they once were. She further pointed out an interesting — albeit perverse — phenomenon: Hospitals that have improved patient safety and addressed problems such as “nosocomial” (hospital-acquired) infections have seen their Medicare revenues reduced. This she attributed to quirks in the payment system.

I don’t want to go into specifics, and I imagine you’d prefer I don’t.

“The new rule will result in hospitals seeing substantial reductions in payment for the care of individual patients with preventable complications,” Rosenthal wrote. She predicted, however, that the change wouldn’t substantially affect total payments to hospitals because they would be reduced only when the preventable complications were the only factors causing an illness to be reclassified under a more expensive diagnostic code.

Translation: It must be clear that additional problem was related entirely to the hospital stay, and the conditions covered are limited. I imagine proving fault will be a challenge.

The importance of the change is that it tip-toes toward “pay for performance.”

“Hospitals may therefore view the new policy as a harbinger of things to come and act in anticipation of more substantial reimbursement changes,” Rosenthal wrote, predicting hospitals may adopt further quality measures as a result of the new rules and improve reporting.

This began in earnest with reporting a limited number of measures, which the public can view at http://hospitalcompare.hhs.gov.

Today it’s pressure ulcers, bed falls and other things that shouldn’t happen. Tomorrow it’s more complicated stuff.

According to Medical News Today, starting in 2009 Medicare won’t cover “preventable” conditions. Because rules don’t allow hospitals to pass on the cost, they must shoulder the burden. Because Medicare and Medicaid participants make up a large percentage of hospital visitors, the agency has tremendous clout nationally to force changes in the health care system.

The commentary in the medical journal and this week’s news on the prevalence of hospital-acquired infections make this a particularly interesting time. I’ll be curious to see how hospitals respond to the change and if there is an effect on the bottom line.

Because information on hospital-acquired infections isn’t publicly disseminated (at least nowhere I’ve found) or reported to the state, determining the extent of the problem is nearly impossible. Maybe this will shed some light on it.

Jeff Raymond, Medical Writer