Investing in an Index Fund tied to the Milliman Medical Index instead of the Dow Jones Industrial Average

By Clive Riddle, May 18, 2017

Milliman has just released their 2017 Milliman Medical Index, which measures the cost of healthcare for a typical American family of four receiving employer PPO coverage. The total family bill is $26,944 compared to $4,518 in 2001. I want to invest in an index fund tied the Milliman Medical Index. The annual rate of return since 2001 would be 11.805%, compared to 3.874% for the Dow Jones Industrial Average during that same time (Dow Jones May 16 2001: 11,215.92; Dow Jones May 16 2017: 20,606.93). Our Milliman Medical Index fund would outperform the Dow index fund by three times.

But since the Milliman index fund only exists in some alternate universe for now, we might as well dive into some of findings Milliman shares in their 12-page report on this year’s index: 

Pharmacy share of costs have increased during this this time (from 13% to 17%) as have Outpatient (from 14% to 19%) while Professional services decreased (from 40% to 30%) and Inpatient remained about the same (from 30% to 31%).

Here verbatim are Milliman’s three key findings:

1. The MMI’s annual rate of increase is 4.3%. This is the lowest rate since we began tracking the MMI in 2001. Yet the total dollar amount is still bracingly high. Of the $26,944 spent by the MMI’s family of four, $11,685 is paid by the employee, through a combination of $7,151 in payroll deductions for premium, and $4,534 in out-of-pocket costs incurred at time of care.

2. Prescription drug trends are lower, but still high. For the first time since 2013 and 2014, the family of four’s prescription drug trends have decreased in two consecutive years. Still, the 2017 prescription drug cost increase of 8% is more than double the medical increase of 3.6%.

3. Employees pay a bigger piece of the healthcare cost pie. Through their payroll deductions and through out-of-pocket expenses incurred when care is received, employees now pay for about 43% of expenses and employers pay the other 57%. The difference between these two shares has gradually narrowed since 2001, when employees contributed 39% and employers contributed 61%. High growth in per-employee healthcare expenditures have pushed employers to limit their contribution increases to amounts below the rate of healthcare inflation.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week: Industry Hopeful Senate Health Care Debate Focuses on Policy, Not Politics The health care industry is hopeful senators will be more receptive to outside groups than their House colleagues were, as the Senate takes the reins on overhauling the Affordable Care Act. Morning Consult. May 11, 2017 Senate GOP making tax credits look more like … Obamacare There’s growing support for making the tax credits more generous for poorer people. Senate Republicans are working on a potential breakthrough that could help push through an Obamacare repeal bill – by making insurance subsidies look a lot like Obamacare. Politico May 11, 2017 CMS Gives States Until 2022 To Meet Medicaid Standards Of Care The Trump administration has given states three extra years to carry out plans for helping elderly and disabled people receive Medicaid services without being forced to go into nursing homes. Kaiser Health News. May 11, 2017 Wednesday, May 10, 2017 Aetna Fully Exits Obamacare Exchanges With Pull-Out in Two States The New York Times reports: Health insurer Aetna Inc said on Wednesday it will exit the 2018 Obamacare individual insurance market in Delaware and Nebraska - the two remaining states where it offered the plans. NYTimes. May 10, 2017 Who will decide what the Senate’s health bill looks like? Follow the Medicaid-state senators. The Senate has broken into a series of “working groups” to begin writing its own version of legislation to replace the Affordable Care Act. There’s the leadership-driven group, a group of moderates and there was talk about a more conservative group before it was mostly absorbed into the leadership group. The Washington Post. May 9, 2017 These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

An Interview With Kaiser’s Robert Pearl, MD on Mistreated Patients and the American Health Care System

By Clive Riddle, May 10, 2017 Doctor Robert Pearl, certainly a prominent figure in American healthcare today, agreed to sit down and expand upon his thoughts on the American health care system in 2017 and its impact upon patients. His new book, Mistreated - Why We Think We're Getting Good Health Care and Why We're Usually Wrong has just been released this month by Public Affairs, and we hoped he would elaborate on some of the questions that come to mind from issues raised in Mistreated, and in his public speaking appearances. Robert Pearl, MD, is executive director and CEO of The Permanente Medical Group, responsible for the health care of 3.8 million Kaiser Permanente members, and he is the president and CEO of the Mid-Atlantic Permanente Medical Group. He is on faculty at Stanford and has taught at Duke, UC Berkeley, and Harvard. His column on Forbes.com addresses the business and culture of health care, and he has been featured in national media including Time, ABC News, USA Today, and NPR. So here’s what Doctor Pearl shared with us in response to our half dozen questions: Q. You have been an influential healthcare stakeholder and thought leader for some time. American healthcare has been problematic for even longer. What confluence of events influenced you to write this book at this juncture? Doctor Pearl: The American health care system is walking towards a cliff, and if nothing is done to change course, we will step over the edge and crash to the ground below. We spend almost 50% more than any other country in the world and our outcomes are in the lower half of industrialized nations. Hundreds of thousands of people die each year from failures in prevention and medical error, including my dad. Our system most closely resembles a 19th century cottage industry. It is fragmented, with doctors scattered across the community and hospitals in every town, piece meal, what we call fee-for-service and using information technology from the last century. The cost is rising faster than our ability to pay. The government is spending 40% of tax revenues on health care today, and with 10,000 people becoming eligible for Medicare every day, that will rise rapidly in the future. And businesses are implementing high deductible insurance products, with patients increasingly unable to pay the out of pocket expense. In other words, the "patient" is becoming critical. I wrote Mistreated for two reasons. The first was my career long desire to make American health care better. And the second to prevent other people from losing their parent prematurely. For both reasons, all profits from the book will be given to charity to provide care to patients unable to access it today. Q. You have written about how healthcare organizations should be less, and not more, regulated in some respects - for example reducing regulation in order to facilitate workflows that would allow hospital patients to get more uninterrupted sleep during the night. You also have written that a single payer system is not the answer for American healthcare. What legislative changes do you advocate in your book? Doctor Pearl: I believe that change can best happen through transparent and fair competition. Making it possible for insurance companies, ACOs and large, multi-specialty medical groups to offer products that patients can understand, compare and choose among would be valuable. I have confidence in the wisdom of people and businesses to make the best selection, once they have broad choice and sufficient information. I also believe that the government needs to address the egregious pricing by many drug companies. The patent laws were written for the greater good of all. They were designed to encourage R&D and focus drug companies on solving the most important clinical problems that exist. They never were designed to allow manufacturers to buy the rights to long standing, inexpensive drugs and raise their prices 500% - 5000 %. Q. You cite three technologies as being key to transforming American health care: Video and digital photography; Data analytics; and EHR. These are not exotic items. So what are some primary factors in 2017 that are still holding us back from deploying these three items at optimal levels? Doctor Pearl: There are three reasons I believe these technologies are not more broadly used. The first is that to use them effectively requires an integrated delivery system that is prepaid with effective physician leadership. Without all three pillars, the information in the EHR will be incomplete, the data analytics difficult to apply, and applications like video economically problematic.  The second reason is physician inertia. According to the Rand Corporation, it takes 17 years for a great idea to become common practice. Finally, when it comes to video and digital, the problem with these technologies is that they are inexpensive. As such, there is no manufacturer or device company that wants to invest the dollars needed to encourage and train physicians to embrace these patient conveniences. And without this level of support change is slow to happen. Q. Speaking of exotic technologies, you are not necessarily the biggest fan of focusing on all things new and shiny, and have cited the challenges in overcoming behavioral biases in that direction. What are some significant examples of technologies that have at this point benefited from undeserved demand from consumers or providers? Doctor Pearl: As you note, as a nation we are attracted to the new and the hyped. A variety of expensive medications fit this description. Often they have minimal improvements over what was previously available, or extend life by a few weeks for most patients.  Another example is Artificial Intelligence. It sounds great, but most of the systems are really just fancy computers with physician developed algorithms, not real self-learning applications. Similarly, expensive fitness trackers are minimally better than the free application on your smart phone. And medical wearable devices can transmit hundreds of heart rhythm tracings, but doctors don't want them cluttering up their EHRs, and rarely do they add value for someone without a known cardiac arrhythmia. Q. You are a strong advocate for clinical integration. What in 2017 are the biggest impediments in urban markets that lack adequate clinical integration? And how do we bring greater clinical integration to rural America? Doctor Pearl: In urban areas, the limitations are the associated changes that need to happen. For integration to add value, you need to create a structure with the right number of physicians from each specialty. Often there are too many or too few in a typical community. For the new structure to add major value, reimbursement needs to change, rewarding prevention and avoidance of medical error as highly as intervention. And altering how doctors are paid is always contentious. The computer systems need to connect, and that is difficult to accomplish today. Finally, physician leadership is essential, and that requires investments in training and a willingness of all to relinquish autonomy. In some ways the rural areas could be easier. In this case I believe the structure can be virtual, with specialists in more urban areas linked to primary care in the rural location. We are already using this type of approach in our on-site clinics located in large businesses. Here specialists whose offices may be in a hospital miles away can consult on a employee needing specialty expertise without having to ask the patient to drive to the physicians' location and miss a day of work. Over half of the time, this solves the patient's problem. Q. In what ways do you hope consumers will change their actions or thought processes as a result of reading your book? And in what ways do you hope other healthcare stakeholders will be influenced? Doctor Pearl: I wrote Mistreated for the patient in all of us. My father was a professional with well trained doctors, and yet, he experienced a medical error from the lack of a comprehensive electronic health record and inability of his doctors to communicate effectively.  The first step to transforming American health care is to help people see what they are missing and why. Having done so, I would hope they would begin to make different choices in the health plan and delivery system they select. Information can be difficult to obtain, but increasingly it is available. Choose a five star program in Medicare or on the health care exchanges. Check to see if there is reported data on outcomes for various procedures like heart surgery, and go to the programs with the best results. Ask physicians before you have a procedure how many of these they did last year, and choose ones with the highest volume. And when you are in a hospital or doctor's office, and anyone fails to wash their hands before examining you, speak up. Specific to the medical profession, my hope is that change will happen soon, rather than waiting for the predictible crisis. The current system isn't working for clinicians any more than patients. The fragmentation that exists today leads to isolation. Fee-for-service makes doctors feel like they are having to run faster and faster, and convince patients they need things done that often add little value. The lack of technology and medical information leads to errors. And the lack of leadership reduces coordination of care and produces growing frustrations in the practice of medicine.  Change always is difficult and scary, but it can happen. And when it does, I believe both patients and physicians will benefit immensely. The current system is broken. I am optimistic that when large numbers of people from diverse backgrounds come together to talk about their experiences and recommendations, that we can improve health care delivery in the future. That is my hope in writing the book. The path I describe is the one I believe best for the nation, but I look forward to learning from others. If Mistreated stimulates discussion, debate and improvement, and as a result tens of thousands of lives are saved each year, then my father's death will have served a purpose.

Different Approaches in Tackling the Surprise Medical Bill Problem

By Clive Riddle, May 5, 2017 Surprise medical bills – from out of network physicians affiliated with network hospitals, and other similar situations – have been a long standing problem vexing consumers, providers, plans, employers and regulators. This simmering issue began boiling over the past few years as growth in narrow networks and ever increasing retail charges exacerbated the problem. Arizona last week had Senate Bill 1441 signed into law: “The legislation, which takes effect in 2019, will allow a consumer with an out-of-network bill exceeding $1,000 to contact the Arizona Department of Insurance to request the appointment of an arbitrator. The insurer and health-care provider must try to settle the dispute through an informal telephone conference within 30 days of the consumer's arbitration request. The case advances to arbitration if the two sides cannot agree to an amount, with the insurer and health-care provider splitting the cost. Either party would have the right to appeal an arbitrator's decision to the county Superior Court.” Oregon, Texas and Nevada, to name some states, currently have legislative activity of different kinds on this front. Gastroenterology & Endoscopy News ran a nice April 20th 2017 article, Out-of-Network Billing: ‘Surprise Billing’ or ‘Surprise Gaps In Insurance Coverage’? that included a great summary of state level initiatives addressing these surprises.  Included in this discussion was: ·         A number of states are linking reimbursement to rates determined by the independent third-party database. ·         In New York  “Hospitals must disclose which health plans they accept and list standard charges for services. Perhaps most important, they must alert patients that physicians working at an in-network facility may not actually participate in the insurance network and can therefore bill patients directly.” ·         “California recently passed a law that settles out-of-network billing disputes by using one of two benchmarks. Providers will be reimbursed the greater of either 125% of Medicare rates or the insurer’s average contracted rate for the same or similar services in the same geographic region.”…but “not surprisingly, the California law is already being challenged in court.” ·         “Florida’s new law sets reimbursement for out-of-network claims at the lesser of: the provider’s charges; the UCR provider charges for similar services in the community where the services were provided; or the charge mutually agreed to by the insurer and the provider within 60 days of the submittal of the claim. The key in Florida moving forward will be how UCR is defined.” The American Journal of Managed Care  has just issued a release discussing an article in their current issue: Battling the Chargemaster: A Simple Remedy to Balance Billing for Unavoidable Out-of-Network Care, in which “two doctors and two lawyers say they have a solution that doesn’t require legislation: better use of contract law…..Authors Barak D. Richman, JD, PhD; Nick Kitzman, JD; Arnold Milstein, MD, MPH; and Kevin A. Schulman, MD, say the problem starts with the ‘chargemaster,’ a hospital’s master list of prices for billable services. The authors say the defining feature of the chargemaster is that it is ‘devoid of any calculation related to cost,’ and has no relation to local market conditions.” They release continues that “acontract law solution empowers the very parties who currently are being exploited by out-of-network charges,” they write. An emerging consensus, supported by a key court ruling, finds that providers are not entitled to ‘chargemaster’ rates, because neither the patient nor the payer agreed to them. Instead, the authors write, the law “entitles providers to collect no more than the prevailing negotiated market prices” for out-of-network care. In other words, rates already negotiated by hospitals, doctors, and area payers are the norm, not those artificially inflated on the ‘chargemaster.’ This leads to a stark conclusion, the authors find. ‘Providers have no legal authority to collect chargemaster charges that exceed market prices for out-of-network services, nor are payers under any obligation to pay such chargemaster prices.’ The authors make their case in a legal analysis available online.” So while “the authors praise state legislators for trying to end surprise medical bills, they say the courtroom is the proper place for these disputes. Other remedies, like bans on out-of-network bills, don’t encourage cost-saving steps or competition.”

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week: Winners And Losers Under The House GOP Health Bill House Republicans have passed a bill to replace the Affordable Care Act. If it is signed into law, the American Health Care Act will affect access to health care for millions of people in the U.S. NPR. May 4, 2017 GOP Senators to Draft Their Own Obamacare Replacement Bill A top Senate Republican said Thursday that even though the House spent months on a health care bill that would repeal and replace the Affordable Care Act, the Senate will use that legislation as a starting point to draft a separate measure. Morning Consult. May 4, 2017. What’s in the AHCA: The Major Provisions of the Republican Health Bill The House health care bill up for a vote on Thursday would roll back the Affordable Care Act’s expansion of Medicaid, eliminate tax penalties for people who do not have health insurance and end taxes on certain high-income people, insurers, drug companies and manufacturers of medical devices to finance the current health law. NYTimes. May 4, 2017 Blue Shield CEO Says GOP’s ‘Flawed’ Health Bill Would Harm Sicker Consumers The chief executive of Blue Shield of California, the largest insurer on the state’s insurance marketplace, issued a blunt critique of the Republican health care bill, saying it would once more lock Americans with preexisting conditions out of affordable coverage. Kaiser Health News. May 3, 2017 NIH to get a $2 billion funding boost as Congress rebuffs Trump’s call for cuts The National Institutes of Health will get a $2 billion funding boost over the next five months, under a bipartisan spending deal reached late Sunday night in Congress. The agreement marks a sharp rejection of President Trump’s proposal to cut $1.2 billion from the medical research agency in the current fiscal year. Stat News May 1, 2017 These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week: U.S. appeals court blocks Anthem bid to merge with rival Cigna A U.S. appeals court blocked health insurer Anthem Inc's (ANTM.N) bid to merge with Cigna (CI.N) on Friday, upholding a lower court's decision that the $54 billion deal should not be allowed because it would lead to higher prices for healthcare. Reuters April 28, 2017 4 key questions surrounding Obamacare repeal House Republicans are mounting yet another effort to tear down Obamacare and remake the health care system — but the path to delivering on one of the GOP's longest-standing priorities remains complicated and fraught with uncertainty. Politico April 27, 2017 Amid budget talks, White House says it will continue ACA subsidies The White House on Wednesday pledged to continue payments critical to the success of Affordable Care Act exchanges, Politico reports. The pledge will come as a relief to insurers and providers after the administration’s earlier indication that it might withhold payments as a bargaining chip in this week’s budget negotiations. Stat News April 26, 2017 PBM Express Scripts loses biggest client Anthem Express Scripts said Monday that its biggest client, Anthem, will not renew its contract with the pharmacy benefit manager after the current agreement expires at the end of 2019. Modern Healthcare April 24, 2017 Health Care In America: An Employment Bonanza And A Runaway-Cost Crisis In many ways, the health care industry has been a great friend to the U.S. economy. Its plentiful jobs helped lift the country out of the Great Recession and, partly due to the Affordable Care Act, it now employs 1 in 9 Americans — up from 1 in 12 in 2000. Kaiser Health News April 24, 2017 These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

What Goes into Combating Healthcare Fraud

By Claire Thayer, April 27, 2017 According to the National Health Care Anti-Fraud Association, most health care fraud is committed by organized crime groups and a very small minority of dishonest health care provider. The NHCAA tells us that the most common types of fraud include: ·         Billing for services that were never rendered-either by using genuine patient information, sometimes obtained through identity theft, to fabricate entire claims or by padding claims with charges for procedures or services that did not take place. ·         Billing for more expensive services or procedures than were actually provided or performed, commonly known as "upcoding"-i.e., falsely billing for a higher-priced treatment than was actually provided (which often requires the accompanying "inflation" of the patient's diagnosis code to a more serious condition consistent with the false procedure code). ·         Performing medically unnecessary services solely for the purpose of generating insurance payments. ·         Misrepresenting non-covered treatments as medically necessary covered treatments for purposes of obtaining insurance payments-widely seen in cosmetic-surgery schemes, in which non-covered cosmetic procedures such as "nose jobs" are billed to patients' insurers as deviated-septum repairs. ·         Falsifying a patient's diagnosis to justify tests, surgeries or other procedures that aren't medically necessary. ·         Unbundling - billing each step of a procedure as if it were a separate procedure. ·         Billing a patient more than the co-pay amount for services that were prepaid or paid in full by the benefit plan under the terms of a managed care contract. ·         Accepting kickbacks for patient referrals. ·         Waiving patient co-pays or deductibles for medical or dental care and over-billing the insurance carrier or benefit plan (insurers often set the policy with regard to the waiver of co-pays through its provider contracting process; while, under Medicare, routinely waiving co-pays is prohibited and may only be waived due to "financial hardship"). While the U.S. Department of Justice, FBI, CMS and other government entities are busy identifying and tracking down fraud schemes, Deloitte research points out that an emerging area of interest in health care fraud and abuse enforcement is that of relationship scrutiny. This weeks’ edition of the MCOL Infographic, co-sponsored by LexisNexis, highlights some of the costs associated with fighting healthcare fraud: (Click to View Full Size Image) (Click to View Full Size Image) MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Clicks-and-Mortar: Health Care's Future

By Kim Bellard, April 27, 2017 The woes of the retail industry are well known, and are usually blamed on the impact of the Internet.  Credit Suisse projects that 8,600 brick-and-mortar stores will close in 2017, which would beat the record set in 2008, at the height of the last recession.   And then there's health care, where the retail business is booming. In a recent Wall Street Journal article, Christopher Mims set forth Three Hard Lessons the Internet is Teaching Traditional Stores.  The lessons are: 1.             Data is King 2.             Personalization + Automation = Profits 3.             Legacy Tech Won't Cut It It's easy to see how all those also apply to health care. But health care is different, right?  Patients want to see their physician.  That physical touch, that personal interaction, is a key part of the process.  It's not something that can be replicated over a computer screen.   Yeah, well, the retail industry has been through all that.  Retail once primarily meant local mom-and-pop stores.  They knew their customers and made choices on their behalf.  But it was all very personal. Still, though, when Amazon came along, booksellers were adamant: no one wants to buy books sight unseen!  When that truism was proven false, other sectors of retail had their turn in the Internet spotlight, and the last twenty years of results haven't been pretty for them.   It turns out that the personal touch isn't quite as important as retailers liked to think. So why hasn't health care been more disrupted by the Internet?  Well, for one thing, when you buy a book online, your state doesn't require that you buy it from a bookstore that is licensed by its not-so-friendly licensing board, as is true with seeing doctors over the internet.   Strike one for disruption. For another thing, we (usually) trust our doctors.  Then again, we used to trust recommendations from bookstore staff too.  That is, when they had time for us, if they seemed knowledgeable, and if they were making recommendations that fit us rather than just their own preferences. Think the same thing won't happen when AI gets better at diagnoses?  Let's go back to Mr. Mims three lessons and see how they apply to health care: ·         Data is King: Health care collects a lot of data, and will get even more with all the new sensors.  The big tech companies know their customers very well and tailor interactions accordingly; health care must as well. ·         Personalization + Automation = Profits:, We're stuck in waiting rooms, filling out forms we've already filled out elsewhere. That is not a personal experience that can survive in the 21st century.  It has to be smoother, faster, and friction-less.   ·         Legacy Tech Won't Cut It: EHRs that no one likes.  Claims systems that take weeks to process a claim.  Billing processes that produce bills no one can understand.   The list could go on almost indefinitely.  All too often, health care's tech is not ready for prime time.   The question is, are health care's leaders learning these lessons? The future of retail appears to be in "clicks-and-mortar" (or "bricks-and-clicks").   Health care can act like B Dalton or Borders, assuming until it is too late that their consumers will visit them in person, because they always had.  Or it can act now to jump to the data-driven "clicks-and-mortar" approach that other retail businesses are moving to.   Health care organizations which get that right will be the one to survive.   This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

6 Ways to Improve Your Member Communications

By Claire Thayer, April 24, 2017 Change Healthcare doubled member engagement for a regional health plan after introducing engagement best practices with a marketing mix that included email, blog posts, social media, a direct mail campaign, presentations to key group leaders and on-site workshops. This special edition of the MCOL Infographic, co-sponsored by Change Healthcare, identifies 6 effective ways for health plans to improve communications with members:  (Click to Enlarge Image) (Click to Enlarge Image) MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

How Do You Build a Culture of Innovation at a Healthcare Organization?

By Clive Riddle, April 21, 2017 Now that we’re thirty days in the Spring of 2017, nurturing seedlings with hopes of taking deeper root should be on the mind of every healthcare gardener. Along these lines, the current issue of Healthcare Innovation News asks their panel the question, “How Do You Build a Culture of Innovation Within Your Organization?” Here’s some excerpts from what these sowers of innovation seeds had to say: David R. Strand, Chief Executive Officer of Life Cross Training, based in Chicago, says in part, “We often point to technology advances as “innovation” in healthcare. Yet, the next real innovation in healthcare will come from our investments in human capital—investments in the people we count on to deliver high-quality care and a great patient experience.  Addressing this problem requires comprehensive, innovative solutions focused in three distinct areas: (1) Improving the practice environment. Systematically identifying and eliminating hassles from technology to process to organizational design and identifying and accentuating those things that bring joy to clinical practice; (2) Aligning teams around common values and shared goals. Establishing guiding principles for interactions with one another and with patients and building cultures that support the well-being of both patients and clinicians; (3) Providing clinicians with evidence-based skills driving individual well-being. Ensuring that clinicians are better equipped to handle the intrinsic stress associated with their work and busy lives. James Polfreman, CEO and President of Solis Mammography based in Addison, Texas echoes the theme that technology is not enough, sharing that  “In the field of women’s breast health, innovation is not only measured in terms of technology and clinical accuracy, but also in areas of patient service, convenience and care to ensure annual compliance and repeat business.” He advises that “to foster innovation, an environment must be actively cultivated to promote openness and collaboration in order to tap into the natural passion of employees. This type of environment benefits the entire team and translates into superior patient care Well-informed teams are vital. Communication of a crystal-clear vision and mission is fundamental……When new ideas are implemented, having clear processes in place from training to implementation is key…..Consistently challenging the status quo motivates initiative….. Finally, a culture of innovation is maintained through leadership by example, repetition and affirmation of a job well done. This influences how you attract, recruit, retain, train and reward teams.” Joanna Engelke, Managing Director at Halloran Consulting Group in Boston counsels in part that “there are numerous best practices cited to support an innovative culture: (A) Enabling employees to spend 5% to 10% of their time on freethinking and creating “skunkworks” projects—those dedicated solely to radical innovation; (B) Creating office designs that encourage “bumping into each other” with lots of light, mobile whiteboards, huddle rooms, collaboration centers and games; (C) Investing in an internal, venture capital-like fund with all the trappings of pitches, business plans, proof of concept and funding milestones that are outside a regular product development arena; (D) Sponsoring crowd-sourced, problem-solving fairs for internal and external participation; (E) Surveying employees to gain an understanding of internal practices that block or prevent innovation; (F)                 Rewarding innovation in each department of an organization.” But Joanna reminds us, “the real secret sauce to an innovative culture is very basic: Management must pay attention.” Finally, Summerpal Kahlon, M.D., Director of Care Innovation at Oracle Health Sciences, based in Satellite Beach, Florida, says we need to listen. “Listening is a key skill in healthcare.” In particular he advocates listening to data through analytics. He cites these as examples that can drive innovation – “There are a few high-value, rich sources of information that can provide interesting lifestyle insight: Demographic information, including occupation, income and family/social environment; Environmental data, including census, local crime statistics and accessible parks/recreation; and Retail data, particularly for grocery and drugstores.”

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week: Lawmakers revisiting requiring those on Medicaid to work A simple question — should adults who are able to work be required to do so to get taxpayer-provided health insurance? — could lead to major changes in the social safety net. AP News. Friday, April 21, 2017 How G.O.P. in 2 States Coaxed the Health Law to Success or Crisis In Oklahoma, which has raged against the Affordable Care Act, insurance premiums are among the nation’s highest. New Mexico, which oversees its marketplace, has one of the lowest average premium costs. The New York Times. Friday, April 21, 2017 White House pressures GOP leaders on Obamacare showdown next week A frantic and impatient White House is pressuring House GOP leaders for another showdown vote on repealing Obamacare next week so it can notch a legislative win before President Donald Trump’s first 100 days in office. Politico. Thursday, April 20, 2017 Sen. Grassley Demands Scrutiny Of Medicare Advantage Plans Sen. Chuck Grassley (R-Iowa) wants federal health officials to tighten scrutiny of private Medicare Advantage health plans amid ongoing concern that insurers overbill the government by billions of dollars every year. Kaiser Health News. Tuesday, April 18, 2017 G.O.P. Bill Would Make Medical Malpractice Suits Harder to Win Low-income people and older Americans would find it more difficult to win lawsuits for injuries caused by medical malpractice or defective drugs or medical devices under a bill drafted by House Republicans as part of their plan to replace the Affordable Care Act. The New York Times. Saturday, April 15, 2017 These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Reducing Emergency Visits and Admissions for Epilepsy Patients: Nationwide Children’s Dr. Anup Patel Answers Our Questions

By Clive Riddle, April 14, 2017 What can a single quality improvement project accomplish at a single hospital? Just ask Nationwide Children’s, who  performed a quality improvement project and found new, simple ways to significantly decrease the number of emergency department visits and hospitalizations in pediatric patients with epilepsy.” They achieved a 28% decline in emergency visits, a 43% decline in admissions and saved $2 million in costs for these patients. By sharing their research findings in the current issue of Pediatrics, and highlighted in Nationwide Children’s research publication Research Now, hospitals, physicians and purchasers performing care management can adopt Nationwide’s approach to their own settings. We are told that “Nationwide Children’s Hospital serves almost 3,500 children diagnosed with epilepsy. In 2012 and much of 2013, the Emergency Department was experiencing approximately 17 visits per 1,000 epilepsy patients per month. In the minds of both Emergency Medicine physicians and epilepsy subspecialists, that was too many.” The hospital shares that “the QI team identified ‘key drivers’ (or contributing factors) of ED visits, and found they centered on provider-to-provider communication issues and patient/family resources, education, beliefs and comorbidities. Then the team began interventions to target those key drivers. Most important was the establishment of an Urgent Epilepsy Clinic,” which they tell us involved family visits lasting 90 minutes or longer, with as little as three days’ notice. Nationwide Children’s also identified that “abortive seizure medication was under dosed (or not given at all). Nationwide Children’s built an alert system into its electronic health records – when a provider entered what appeared to be an incorrect dosage based on size and age, the provider would be notified of the proper dose.”  Their additional interventions developed from the project included a color-coded seizure action plan, which helped caregivers understand what a baseline seizure looks like and when to call Neurology; and a personalized magnet giving caregivers information about how to give abortive seizure medications.” The results? Emergency visits reduced from 17.0 to 12.2 per month per 1,000 children epilepsy patients during the past year. The average number of inpatient epilepsy children hospitalizations per month was reduced from 7 admissions per month per 1000 patients to 4 admissions per month per 1000 patients.  Anup Patel, MD, a pediatric epileptologist and member of the Division of Neurology at Nationwide Children’s, and leader of the QI project and resulting research paper was nice enough to respond to some follow-up questions I asked after reading about the project. First, I asked  him what is the approximate epilepsy incidence/1,000 population (pediatric preferably). He shared this information from Epilepsy.com which he recommends as a great source information on epilepsy: Epilepsy is the 4th most common neurological problem – only migraine, stroke, and Alzheimer’s disease occurs more frequently. There are many different ways to explain how often a disease occurs. Here’s a few points to consider. What is the incidence of epilepsy in the United States? ·         The average incidence of epilepsy each year in the U. S is estimated at 150,000 or 48 for every 100,000 people. ·         Another way of saying this- each year, 150,000 or 48 out of 100,000 people will develop epilepsy. ·         The incidence of epilepsy is higher in young children and older adults. This means that epilepsy starts more often in these age groups. ·         When the incidence of epilepsy is looked at over a lifetime, 1 in 26 people will develop epilepsy at sometime in their life. ·         Seizures are the number on most common Neurologic Emergency that we see in children. What is the prevalence of epilepsy in the United States? There are many different estimates of the prevalence of epilepsy. These numbers vary depending on when the studies were done, who was included, and a host of other factors. ·         The number of people with epilepsy, using prevalence numbers, ranges from 1.3 million to 2.8 million (or 5 to 8.4 for every 1,000 people). ·         The estimate currently thought to be most accurate is 2.2 million people or 7.1 for every 1,000 people. ·         However, higher numbers of people report that they have active epilepsy, 8.4 out of 1,000 people. These numbers are even higher when people are asked if they have ever had epilepsy (called lifetime prevalence). 16.5 per 1,000 people reported that they had epilepsy at some point in their life. Next I asked him about the second intervention in the project regarding abortive seizure medication under dosed or not given. How much is medication adherence/compliance an issue for this population?  Dr. Patel responds that “We know that medication adherence to daily seizure medications is a risk factor for ED visits in patients with epilepsy.  In regards to abortive seizure medication (medication given for long or repeat seizures), we found under dosing was an issue (previous literature – Patel in Epilepsy and Behavior 2014) and that parents were either anxious, did not remember, or did not get proper instruction on how to give medications.” Noting that the project identified comorbidities as a key driver, I asked him what are the typical comorbidities? He replied “Developmental delay, autism, cerebral palsy, depression, and anxiety.” I asked Dr, Patel to elaborate on the calculation that their interventions yielded $2 million in annual savings. He responded that “our average ED visit was $640 and a subsequent hospitalization averaged $14,500 in claims paid. When you look at the reduction of both ED visits and the hospitalizations associated with the ED visit, you get the $2 million savings per year”. Lastly, I asked if a similar approach work for an adult population as well. The short answer is yes.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week: Bipartisan Senate Bill Takes Step Against Opioid Epidemic Morning Consult reports: A bipartisan Senate bill unveiled Thursday would impose strict limits on some opioid prescriptions, a small tweak to federal law that is part of an ongoing effort in Congress to curb overuse of the drugs. Morning Consult. Thursday, April 13, 2017 States Moving More Medicaid Patients To Managed Care Private health insurance companies stand to reap a bigger share of the Medicaid business as states deal with budget shortfalls and increased spending on medical care. Forbes. Thursday, April 13, 2017 Trump Signs Law Giving States Option To Deny Funding For Planned Parenthood President Trump quietly signed legislation Thursday that rolls back an Obama-era rule protecting certain federal funds for Planned Parenthood and other organizations that provide legal abortions. NPR. Thursday, April 13, 2017 Trump administration issues final rule on stricter Obamacare enrollment The Trump administration on Thursday issued a final rule that will shorten the Obamacare enrollment period and give insurers more of what they say they need in the individual insurance market, likely making it harder for some consumers to purchase insurance, healthcare experts said. Reuters. Thursday, April 13, 2017 Repeal, Replace … Revise: Your Guide To How A Trump Proposal Might Change ACA Insurance Repeal and replace is on-again, off-again, but that doesn’t mean the rules affecting your insurance will remain unchanged. The Trump administration’s proposed rule aimed at stabilizing the health law’s insurance marketplace could have rapid, dramatic effects on people who do not get insurance through work and buy it on the Affordable Care Act’s exchanges. Kaiser Health News. Thursday, April 13, 2017 These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Health Plans and the Opiod Abuse Crisis

By Clive Riddle, April 7, 2017 The Associated Press reports that Dr. Scott Gottlieb, “the doctor nominated to head the powerful Food and Drug Administration told senators Wednesday that his first priority would be tackling the opioid crisis.”  What are health plans doing about Opiod Abuse? Last June, the California Health Care Foundation released  a report taking the issue on: Changing Course: The Role of Health Plans in Curbing the Opioid Epidemic, along with companion California health plan case studies and an infographic. Nationally, last fall AHIP weighed in, discussing how health plans are Fighting Opioid Abuse With Solutions That Work. So what are some current developments on the health plan Opioid Abuse front? Cigna has just announced that Use of Prescribed Opioids Down Nearly 12 Percent Over 12 Months Among Cigna Customers. Cigna reports that “58 medical groups participating in Cigna Collaborative Care, representing nearly 62,000 doctors, have signed Cigna's pledge to reduce opioid prescribing and to treat opioid use disorder as a chronic condition.” Cigna states that their program works with participating doctors to: (1) Analyze integrated claims data across pharmacy and medical benefits to detect opioid use patterns that suggest possible misuse by individuals, and then notifying their health care providers; (2) Alert doctors when their opioid prescribing patterns are not consistent with CDC guidelines; and (3) Establish a database of opioid quality improvement initiatives for doctors. Cigna also reports that “effective July 1, most new prescriptions for a long-acting opioid that are not being used as part of treatment for cancer or sickle cell disease, or for hospice care, will be subject to prior authorization, and most new prescriptions for a short-acting opioid will be subject to quantity limits.” Last week the Wisconsin Association of Health Plans announced their member plans have jointly committed to combating opioid abuse and addiction in Wisconsin and effective April 1, Wisconsin's community-based health plans are collaborating on new initiatives.  The Association members agreed to: (1) support the Association’s Statement of Principles for addressing opioid abuse  that “form the basis for sharing information, best practices and evidence-based strategies”; (2) Track morphine equivalent dose and first-time user trends for their individual and employer group members,, generating comparative data to enrich provider education and management of prescription drug formularies and coverage policies; (3) Work with provider partners to support strategies to reduce and control the level of opioid prescribing; (4) Share methodologies, best practices and evidence-based strategies to improve the quality of pain management and opioid prescribing; and (5) Ensure that every member suffering from opioid abuse has access to medically-appropriate treatment options. Two weeks ago BlueCross BlueShield of Western New York released episode four of their Point of Health Audiocast, “Addressing the Opioid Epidemic from a Health Plan Perspective,” aimed at increasing awareness of the issue and engaging stakeholders. FamilyCare Health, a health plan serving Oregon Medicaid and Medicare members, “kicks off its 4-part Opioid Training series for providers on Thursday, April 27, 2017 with ‘Buprenorphine: What we know and what we don’t. Prescribing safely for pain management and opioid dependence.’ “ And last week, Prime Therapeutics, the Blue Cross Blue Shield Association PBM, released two studies, highlighting strategies for addressing opioid epidemic.  The first study “analyzed concurrent use of opioids with benzodiazepines”, citing “previous research has shown concurrent use of these two types of drugs can increase the risk of overdose and death,” and “found more than one in six opioid users without cancer – or nine per 1,000 commercially insured members – used these two drugs concurrently for 30 days or more in 2015.” Their second study “found pharmacists based in a PBM or health plan, who do outreach to prescribers, can reduce emergency room visits and controlled substance drug costs among persistent users of controlled substances.” Following the outreach conducted with the study intervention group, “controlled substances drug costs per member for the intervention group dropped from $5,802 to $5,148, while controlled substance drug costs increased for the control group from $3,511 to $3,627 per member. Emergency department visits were 6.4 percent lower in the intervention group, compared with the control group.”

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week: No Obamacare cease-fire in red states The epic collapse of the Obamacare repeal bill created an odd opportunity for 19 states that have long shunned Medicaid expansion. Politico, Friday, March 31, 2017 Pence breaks tie, allowing Senate to revoke Obama order on abortion provider funding Vice President Mike Pence returned to the Senate Thursday afternoon -- the second time in one day -- to cast a tie-breaking vote on legislation to undo an Obama-era regulation on funding for abortion providers. The Hill, Thursday, March 30, 2017 House GOP Weighing Another Try on Obamacare Vote Next Week House Republicans are considering making another run next week at passing the health-care bill they abruptly pulled from the floor in an embarrassing setback to their efforts to repeal Obamacare. Bloomberg, Wednesday, March 29, 2017 Senators Demand Answers About Possible Probe Of HHS Secretary Price Nine senators are pushing U.S. Attorney General Jeff Sessions to reveal what he knows about a reported investigation into Health and Human Services Secretary Tom Price’s stock trades that a top federal prosecutor might have begun before being fired by the Trump administration this month. Kaiser Health News, Wednesday, March 29, 2017 Justice Department Joins Lawsuit Alleging Massive Medicare Fraud By UnitedHealth The Justice Department has joined a California whistleblower’s lawsuit that accuses insurance giant UnitedHealth Group of fraud in its popular Medicare Advantage health plans. Kaiser Health News Tuesday, March 28, 2017 These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Driving Consumer Engagement with Powerful Provider Directories

By Claire Thayer, March 30, 2017 First impressions really do matter, especially with the millennial generation. A recent article published by Modern Healthcare tells is that “millennials are more than twice as likely as older patients to research providers on websites such as Yelp, Consumer Reports and Angie's List. A third of millennials said they have switched providers when dissatisfied, 12 percentage points higher than that of other generations.” The provider directory is often the vehicle for the patients’ first impressions on the scope of the provider health care network and related facilities.  Additionally, Medicare providers are putting revenue at risk when not getting first impressions right, with quality scoring now being tied to overall patient satisfaction. This week, a special edition of the MCOL Infographic, co-sponsored by LexisNexis Health Care, highlights the role of the provider directory and its importance in overall consumer engagement:

Disobey, Please

By Kim Bellard, March 29, 2017 The M.I.T. Media Lab is taking nominations for its Disobedience Award, which was first announced last year.  As the award's site proudly quotes Joi Ito, the Director of the Lab and who came up with the idea: "You don't change the world by doing what you are told." I love it.  The site, and the award's proponents, make clear that they are not talking about disobedience for the sake of disobedience.  It's not about breaking laws.  They're promoting "responsible disobedience," rule-breaking that is for the sake of the greater good.  The site specifies: This award will go to a person or group engaged in what we believe is an extraordinary example of disobedience for the benefit of society."    In Mr. Ito's original announcement, he elaborated: The disobedience that we would like to call out is the kind that seeks to change society in a positive way, and is consistent with a key set of principles. The principles include non-violence, creativity, courage, and taking responsibility for one's actions."  The creators of the award are probably not thinking much about health care -- despite disavowing it is about civil disobedience, many examples they've given revolve around people resisting what they think are improper government actions -- but they should be.  If there's a field where lots of stupid, or even bad, things happen to people , through design, indifference, or inaction, health care has to be it. The list of disobedient acts in health care that would serve society is longer than my imagination can produce, but here are some examples: ·         The nurse who says, no, I'm not going to wake up our patients in the middle of the night for readings no one is going to look at. ·         The doctor (or nurse) who knows a doctor that they believe is incompetent and decides, I'm going to speak up about it.  I'll make sure patients know. ·         The billing expert who decides, no, I'm not going to keep up the charge master, with this set of charges that aren't based on actual costs and which almost never actually get used (except by those unfortunate people without insurance).  Instead, we'll have a set of real prices, and, if we give anyone any discounts, they will be based on ability to pay, not on type of insurance. ·         The EHR developer who realizes that, it's silly that this institution's EHR can't communicate with that institution's EHR, even though they use the same platform and/or use the same data fields.  . ·         The insurance executive who vows, I'm tired of selling products that are full of jargon, loopholes, and legalese, so that no one understands them or knows what is or isn't covered.  We're going to sell a product that can be clearly described on one page using simple language. ·         The practice administrator who understands that patients' time is valuable too, and orders that the practice will limit overbooking and will not charge patients if they have to wait longer than 15 minutes.  ·         The medical specialty that commits to being for patients, not its physician members, by developing measures, specific to patient outcomes, in order to validate ongoing competence. Going back to the award's principles of non-violence, creativity, courage, and taking responsibility for one's actions -- well, the above would all seem to fit.  They're all achievable.  It only takes someone to stand up and decide to do them. This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

What Hashtag to Use When Firing Off a Post on Healthcare Reform?

By Clive Riddle, March 24, 2017 You want more people to read everything you have to say about whichever side of the wall you’re on in the great repeal and replace debate. Or you just want to know what trendy term to search on so you can read what everyone else is saying on the subject. What hashtag to use…what hashtag to use? We compiled a list of the hashtags surrounding the debate and had them analyzed using keyhole.co, which tracks twitter usage during the past 36 hours or so. As of noon Eastern time today, here’s what we found for twenty one selected hashtags that had surfaced the most during our research, presented in alphabetical order: ·         #aca 705 posts | 2,191,075 reach ·         #ahca 405 posts | 18,106,544 reach ·         #BecauseOfMedicaid 500 posts | 302,037 reach ·         #coveragematters 272 posts | 448,981 reach ·         #fullrepeal 50 posts | 1,400,049 reach ·         #healthcarebill 94 posts | 4,154,646 reach ·         #healthcarereform 595 posts | 4,472,503 reach ·         #IfILoseCoverage 391 posts | 1,232,293 reach ·         #killthebill 729 posts | 2,153,734 reach ·         #MakeAmericaSickAgain 703 posts | 935,553 reach ·         #NoRepealWithoutReplace 31 posts | 28,318 reach ·         #obamacare 85 posts | 43,583,728 reach ·         #passthebill 704 posts | 48,210,419 reach ·         #ProtectOurCare 707 posts | 2,217,826 ·         #readthebill 589 posts | 1,871,228 reach ·         #RepealAndReplace 706 posts | 44,990,188 reach ·         #ryancare 706 posts | 2,365,314 reach ·         #saveaca 705 posts | 2,234,518 reach ·         #SaveMedicaid 43 posts | 124,503 reach ·         #SaveTheACA 711 posts | 2,061,039 reach ·         #trumpcare 736 posts | 1,741,593 reach The number of posts vs reach reflects the number of tweeters vs the number of tweetees. One tweet from @realDonaldTrump of course goes a long ways in reach. The top ten hashtags in order of posts during this period were: #trumpcare, #killthebill, #savetheaca, #protectourcare, #repealandreplace, #ryancare, #aca, #saveaca, #passthebill, #makeamericasickagain. These were the only hashtags with 700+ posts, with a range of 703-736, so all are being used with similar frequency, and usage of other  hashtags in this genre really drop off after these top ten. With regard to reach, #passthebill, #repealandreplace, and #obamacare were the top three, each exceeding 40 million. #ahca was fourth with 18+ million. #Healthcarereform and #healthcarebill were next, each with 4+ million and it drops off from there. A number of the hashtags (#killthebill, #passthebill) will fall out of use once the #ahca legislative debate is over, while other monikers will likely have legs for some time to come. So pick your hashtag and start posting or browsing.

Taking a Peek at the Irish Healthcare System on Saint Paddy’s Day

Clive Riddle, March 17, 2017

In observance of St. Patrick’s Day – that day on which we are all Irish – let’s take a quick peek at the Irish healthcare system. Ireland’s Health Service Executive provides all of Ireland's public health services in hospitals and communities across the country. Here’s what their website has to say about their public services:

“Who can access health services in Ireland? Ireland has a comprehensive, government funded public healthcare system. A person living in Ireland for at least one year is considered by the HSE to be 'ordinarily resident' and is entitled to either full eligibility (Category 1) or limited eligibility (Category 2) for health services. People who have not been resident in Ireland for at least one year must satisfy the HSE that it is their intention to remain for a minimum of one year in order to be eligible for health services. Dependants of such individuals must also contact the HSE to confirm their eligibility.” The website informs us that over 30% of people in Ireland are Category 1.

A recent article in Irish Times: Ireland worst of 36 countries for ease of access to healthcare – details recently released negative findings from the annual Euro Health Consumer Index report. The report states “the fact that Ireland has the highest percentage of population purchasing duplicate healthcare insurance – over 40 per cent, down from 52 per cent three years ago – also presents a problem. Should this be regarded as an extreme case of dissatisfaction with the public system, or simply as a technical solution for progressive taxation?”

The article cites these negative findings from the report:

  -  Irish patients spend longer waiting for emergency treatment in hospital than any others in Europe

  -  Ease of access to the Irish healthcare system is the worst of the 36 countries surveyed, with longer waiting times for minor operations and CT scans

  - Overall, the Irish system ranks 21st [out of 36] in the 2016 Euro Health Consumer Index, the same as in the previous year.

  - The Irish health service is also fifth-worst – on a composite “bang for your buck” measure included in the report.

MCOL’s Global Member website includes an archive of International Healthcare Factoids. Here’s some recent selected Irish healthcare factoids from the archive:

Healthcare Spending in Ireland

* Health accounted for 9.91% of Irish gross domestic product (GDP) in 2014.

* Government spending on health has increased by at least €1 billion since 2014.

* Total health spending came to more than €19 billion in 2014.

* €13.3 billion was spent by the Government on health in 2014.

* Household out-of-pocket spending was almost €3 billion in 2014.

* Ireland spent €4,147 per person on health in 2014, the sixth highest total in Europe.

Source: Irish health spending among highest in Europe

Cancer in Ireland

* 38,000 people are diagnosed with cancer each year in Ireland.

* In Ireland, 8,700 people die of cancer annually.

* 1 in 3 Irish men, and 1 in 4 women, will be diagnosed with cancer at some point.

* The chances of Irish women getting cancer is 16% above the EU average.

* The incidence of cancer among Irish men is 10% higher than the EU average.

* 6 out of 10 people will now survive at least five years after diagnosis.

Source: Risk of Irish men and women developing cancer levels off

Hospital Wait Times in Ireland

* More than 530,000 people are on public hospital waiting lists in Ireland.

* 435,000 patients were waiting for an outpatient appointment at the end of August.

* More than 74,000 of these outpatients have been waiting for an appointment for over a year.

* 43,000 have been waiting longer than the 15-month "maximum" waiting time set by the government.

* The hospital with the longest waiting list is University Hospital Galway, at 33,000.

* 78,500 people are waiting for inpatient or day case procedures.

Source: Record 530,000-plus patients on hospital waiting lists

Prevalence of Undiagnosed Type 2 Diabetes in Ireland

* An estimated 24,000 to 40,000 people in Ireland have undiagnosed type 2 diabetes.

* The risk of having undiagnosed type 2 diabetes increased by 89% for every 5kg/m2 increase in weight.

* Men were nearly 3X more likely to have abnormal blood sugar and undiagnosed diabetes than women.

* 17% of participants in a 30,000-person study had abnormal initial fasting blood sugar levels.

* Pre-diabetes was confirmed in 10% of study participants.

Source: Up to 40,000 people have undiagnosed type 2 diabetes, charity says

Under-Age-Six Physician Visitation Rates, Ireland

* Research carried out by the Department of Health last year shows that fee-paying children under the age of six have an annual GP visitation rate of 2.7

* Medical/GP visit cardholders under the age of six have a visitation rate of 3.1

*  GP numbers in Ireland have been increasing since 2010. At December 31 2013, there were 2,840 GPs in Ireland compared to 2,731 at the end of 2012, 2,562 at the end of 2011 and 2,270 at the end of 2010.

Source: Under-six visitation data revealed

Private Health Insurance in Ireland

* 2.123 million people – or 46.3% cent of the population – held private health insurance in September 2012. This represents a drop of 16,000 since March and a decrease of 61,000, or 4%, since June 2011.

* The number of people holding private health insurance peaked in 2008 at 2.3 million, but has been in decline since.

*  Aviva increased its share of the health insurance market last year. In 2011 Aviva grew its market share in Ireland to 17.7%, up from 13.7% the previous year.

* Over the same period VHI Healthcare’s market share fell from 61.6% to 57.3%.

*  Quinn Healthcare's – renamed Laya Healthcare earlier this year – share of the market remained steady at just under 21%.

Source:  Private health insurance numbers fall another 61,000

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

GOP’s 3-Bucket Strategy To Repeal And Replace Health Law Is Springing Leaks

Kaiser Health News reports: Republicans in Washington working to overhaul the Affordable Care Act say their strategy consists of “three buckets.” But it appears that all three may be leaking.

Price dodges on Medicaid rollback, immunization

Politico reports: Confronted by Medicaid recipients during a televised town hall event on CNN, Health and Human Services Secretary Tom Price offered few details Wednesday when asked to explain the reasoning behind the GOP's plan to roll back the health care program.

GOP Health Bill Narrowly Clears House Budget Committee

Morning Consult reports: The House Budget Committee on Thursday narrowly advanced the Republican health care bill to repeal and replace significant parts of the Affordable Care Act, with three Republicans voting against the measure.

By The Numbers: Trump’s Choice For FDA Chief Is Versatile, Entrenched In Pharma

Kaiser Health News reports: President Donald Trump’s pick to lead the Food and Drug Administration has deep ties to the pharmaceutical industry as a consultant, investor and board member. Scott Gottlieb, 44, also has worn many hats in a career that included two previous stints at the FDA, practicing as a physician, and writer/editor roles at prestigious medical journals.

Deciphering CBO’s Estimates On The GOP Health Bill

Kaiser Health News reports: The Congressional Budget Office is out with its estimate of what effects the Republican health bill, “The American Health Care Act,” would have on the nation’s health care system and how much it would cost the federal government. The GOP plan is designed to partially repeal and replace the Affordable Care Act passed during the Obama administration.

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.