Donald Trump and his magic pen…

Trump Administration Preparing Executive Order on Health-Cost Disclosure

President Trump is expected to release an executive order as early as next week to mandate the disclosure of prices in the health-care industry, according to people familiar with the discussion.

[OCS: this is where I ask, So What? So consumers and others can see a price list, now what?]

The order could direct federal agencies to pursue actions to force a host of players in the industry to divulge cost data, the people said. The administration is also looking at using agencies such as the Justice Department to tackle regional monopolies of hospitals and health-insurance plans over concerns they are driving up the cost of care, according to two people familiar with the discussions.

The White House declined to comment on its plans. Industry groups said the initiatives under consideration are an executive overreach and legal challenges are possible.

<Source: Wall Street Journal>

Nothing angers me more than politicians and “experts” saying “all you have to do is …” followed by some government-imposed administrative rule …

It appears that the Department of Health and Human Services will receive an executive order to issue a proposed rule regarding price-transparency, ostensibly to make purchasing medical care more like the rest of the economy, and less like today’s secretive and frustrating morass.

Saying it is not the same as doing it…

The four areas of emphasis are the following: giving consumers greater control over health information through interoperable and accessible health information technology; encouraging transparency from providers and payers; using experimental models in Medicare and Medicaid to drive value and quality throughout the entire system, and removing government burdens that impede this value-based transformation.

[OCS: Electronic Health Records has been a costly boondoggle and has yet to provide any semblance of value to consumers. In most cases, patient portals are little more than email messaging systems that allow access to limited information. In many cases, these systems have been a burden on physicians – many of whom are now followed by a “scribe” to capture impressions, prescriptions, and procedural information.

Encouraging, but not mandating, price transparency is a bureaucratic joke.]

The key theme uniting these four priorities is the recognition that value is not accurately determined by arbitrary authorities or central planners. It is best determined by a marketplace of many players — in the case of healthcare, patients and, where necessary, their third-party payers. Each piece of our plan for value-based transformation recognizes this, and it’s the main reason I am optimistic that we may have more success, and sooner, than past efforts.

[OCS: The statement “value is not accurately determined by arbitrary authorities or central planners” appears to be oxymoronic since the legislation and administrative rules and regulations are crafted behind closed doors in Washington, D.C. Has anyone noticed that the major third-party payers still cling to regional monopolies and do not compete across state lines? ]

In recent years, we’ve seen substantial advances in terms of adoption of electronic health records by providers, but all too often, this simply meant putting in electric form what had been on paper, at great expense and burden to the provider.  Useful, but hardly realizing the promise of health IT. And this shift almost entirely left the patient out of the picture. It’s not just that the benefits of health IT aren’t always apparent to patients—it’s that unless we put this technology in the hands of patients themselves, the real benefits will never arrive.

[OCS: I am an IT expert and my electronic health records may prompt questions on abnormal test results, but otherwise they contain no actionable information. Many times I am frustrated that information captured over multiple visits to multiple doctors conflicts with the information displayed and there is no reasonable or rational means for correcting mistakes.]

Empowering consumers and individuals has been key to the advances of the information age. Think about how we now often make restaurant reservations, through apps like Open Table. From the restaurant’s perspective, there was nothing wrong with a ledger of reservations or, maybe, a business-focused program for tracking tables. But as a consumer, you had to call from restaurant to restaurant to understand when and where there were tables available. Now, if I pull out my smartphone to make a reservation for dinner on a Saturday night, I have all that information at my fingertips. I’m not depending on the person who answers the phone to get it right. I’m the one in control of the whole process: I can see the available choices, I make an informed decision, and I’ve got the record in my hands.

[OCS: I am willing to bet that restaurants honor their reservations far better than physicians and facilities honor their appointment times. In a number of cases, the automated systems will show multi-month waits for available appointments and make no allowances for urgent matters. I have yet to see a flag for an urgent appointment on any of the larger portal systems.]

We already have the technological means to offer this power to patients, but it hasn’t yet happened. The key to this administration’s approach will not be micromanaging the standards and processes used.

[OCS: Available technology does not always drive consumer acceptance. It is driven by need, convenience, and availability.]

<Source> Remarks on Value-Based Transformation to the Federation of American Hospitals by the Secretary of Health and Human Services, Alex M. Azar II, to the Federation of American Hospitals, March 5, 2018, Washington, D.C.

A little extra … Azar is a politician (former Deputy Secretary of Health and Human Services), lawyer (Yale Law School), pharmaceutical lobbyist (Biotechnology Innovation Organization), and former drug company executive (Eli Lilly and Company).

An informed decision, my ass.

In response to Trump’s proposed action, I saw one of those nonsensical headlines in the conservative National Review, “Liberate Americans to Shop for Medical Care.”

Most Americans struggle with the decision about what vehicle to purchase and how much they are willing to pay. They are guided through this transaction by sales people who quickly realize that they need to kill to eat – or be terminated. They practice deception, role-playing, and meeting objections. They hand you a standard price list containing the Manufacturer’s Suggested Retail Price (MSRP) and a copy of what they purport to be an actual invoice for the vehicle in question. It is up to you to negotiate an acceptable initial offer – over which the haggling begins. Of course, they never tell you about the spiffs (bonuses) they receive for pushing a particular vehicle, not about the “dealer-holdback” which is paid to the dealer by the manufacturer, nor about the financing incentives, or the true cost of accessories – many added on by the local dealer to up-price the vehicle, nor any of the tricks involving your “trade in.”

At least with a vehicle, there is a common understanding of function, utility, and the result may not be life-threatening unless they lack the skill to drive the vehicle you purchase.

The truth about medicine: is it is a matter of trusting your physician and the facilities and services within your local environment. With few exceptions, you will seek the care, and use the specialists, recommended by your physician.

Not everybody is as fortunate as I am to be located in an area where world-class hospitals (UCLA, USC, CEDARS-SINAI, ST. JOHNS, PROVIDENT) and renown medical specialists abound. And not everybody can project their medical requirements in advance to ensure that they actually can afford the care they may desperately need.

One need only look at the pricing shenanigans involving pharmacy benefit managers, durable medical equipment providers, and hospitals who use “allocated overhead” to grossly inflate the price for their services. You cannot compete against these people. Hell, even Medicare cannot compete against these people considering the amount of waste, fraud, and abuse that is rampant in the medical environment. And, in many cases, it is not only the patients, but the physicians, who are being systemically screwed as they are given patient volume quotas, hospital admissions quotas, and the necessity to “sell” particular goods and services or risk their own compensation.

Knowing the price of something and attempting to use that information are two different things.

Another joke from HHS, “The public plays an important role in the rulemaking process by commenting on proposed rules. Your comments can help shape the Department’s decisions.” Read the submissions and you will find that most of the formal comments come from special interest groups, many with lobbying clout, or activists with media access. Most rules are written in a language that resembles English in that you can read and understand the meaning of the words – but, use dense legalese or reference other rules and regulations down to the sub-sub-sub-paragraph and sentence level, often changing a single word. A million-dollar change from “shall” to “may” would be clearly understandable to the policy wonks and special interests but be totally opaque to the average individual.

Bottom line …

All it takes is a ruling from a partisan activist judge to bollix up the works. Especially if the proposals come from the Trump Administration and appear to conflict with Obama’s signature medical monstrosity.

We are so screwed.

-- steve

“Nullius in verba.”-- take nobody's word for it!

“Beware of false knowledge; it is more dangerous than ignorance.”-- George Bernard Shaw

“Progressive, liberal, Socialist, Marxist, Democratic Socialist -- they are all COMMUNISTS.”

“The key to fighting the craziness of the progressives is to hold them responsible for their actions, not their intentions.” – OCS

"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius

“A people that elect corrupt politicians, imposters, thieves, and traitors are not victims... but accomplices” -- George Orwell

“Fere libenter homines id quod volunt credunt." (The people gladly believe what they wish to.) ~Julius Caesar

“Describing the problem is quite different from knowing the solution. Except in politics." ~ OCS