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American Medical Association and American Hospital Association Said Both Should Work with Insurers and set aside Adversarial His

Posted Jun 09 2009 12:17pm

After reading the headlines, I wonder how many members were maybe lost here.   I have heard from several doctors that they have discontinued their membership in the AMA, and this is over a few years, not all just recent.  One item that is perhaps a positive would be a better exchange of information, but again the stage was set by the insurers on who and what they paid based on complicated algorithms, so even with perhaps a better working relationship, the trust is still not there, and information shared will continue to be guarded. 

As I posted yesterday, one doctor said to be sure to have an MD that works with you, the patient, and keeps 2 sets of records.  In another related post, over half the doctors felt lying was ok to help patients get the medical attention they need too.  Given both those facts, is there a whole lot that is going to change, probably not. 

Hospitals and Doctors Financials not Improving

We still have one carrier who believes this:

United Health Care Says Cheaper Efficient Doctors and Reducing Hospital Visits by the Elderly Would Help Reduce the Cost of Healthcare

On the other side of the coin though with politics, there’s a new strange alliance beginning as hospitals have cut back so much due to lack of funds that some at hospitals are beginning to support the case of not having a national plan, which when you look at it, who pays their salaries too, and probably anyone who was in the same boat might do the same to protect their paycheck too, so it may not be their interest at heart, but again through lack of money and the low contracts over the years, they jump over to the side that pays, sad but the patient ends up the loser with payers dictating healthcare at that point, not doctors.   One important thing to remember about the risk management business is that it is not the patient or people business and dollars and profits mean all, so as long as the numbers can justify an acceptable statistic on fatalities crossed with the care they dictate, nothing changes. 

image Risk management loves medical reporting devices too as this provides the data analysis to have the potential to dig even deeper to find reasons to perhaps deny and adjust claims, and that is another issue of it’s own, as there are no laws out there and medical reporting devices are sneaking into play quickly with incentives for employees who use them to report in their readings of how much activity and sleep they have in a day and there’s more potential than just those numbers.  We have all read the stories about those getting payments rescinded over a case of acne or yeast infection they forgot to report, so I don’t believe there’s a level where this would top off and a consenting employee or individual signs their privacy life away with access as new levels of intermediate centers are instituted, so now it may not be a straight shot to the PHR. 

They have business intelligence software and methods to offer to help, but where’s the balance in all of this?  Insurers have formed Venture Capital ventures to keep financing the creation of more of this type of software and gosh knows there’s no shortage of it on the market today.  If you work at a hospital as a clinician be on the look out for additional cost algorithms to deal with as this scrutinizes to the absolute bottom line. 

Today it was all over the news about the new iPhone, which is a great phone and it has the hardware to work with the software that can do a lot of image real time tracking and send it to a wellness coach, where ever they might be, as I see various ads on Craig’s list for wellness coaches recently that pay about $8.00 an hour that come with training, and I don’t know who the potential employers are here.  Again, once more a good reason to channel this through a PHR where the patient is in control, but is it destined to be an “insurance device” too? 

This could be good news though for the employees over at Target though as who knows with the incentives that could be available to employees through their insurance plan who has the capability of tracking employees electronically in this fashion, maybe they might be given a discount.  Here’s the software that uses the hardware in an iPhone that is free to download, and it is classified as a game, but for anyone who wants to give it a try, I think the game version is a worth looking at as it is presented in a form that does promote good healthcare.   You even program in where you are going to keep your iPhone too. 

I think the FDA, probably by accident just became involved in medical records too with the approval of a reporting device that connects to other reporting devices.  They might as well as we already have the FTC involved too.

PHRs getting a new watchdog – The FTC to Help Protect Privacy

I’m not sure exactly what any of them are doing, but statement have been made.  The device reporting data is indeed becoming a portion of a medical record and should be viewed as a component too, but do they know that?  You have to perhaps be a bit of a technology person to envision how all this plays out so we can get laws out there after the fact when the damage may already be done. 

Where are the role models too, would a CEO think about using a PHR too?  I haven’t heard of one yet make any announcements, but everybody who has never used one seems to tell us all how good it is, I use them though I think they good and gives me the ability to pick and choose what I want to share and with whom. 

We all have changing roles today and they all seem to go to where the money is for sure.  The AMA is down quite a bit of revenue from years past too, so again some strange bedfellows seem to be appearing from what we have seen in the past and maybe that lawsuit against Ingenix might add some money back into the till.  Also in the news this week were a couple articles about how the life insurance business makes a lot of money investing in the tobacco companies so they get the money both ways around. 

So how ever this end up with insurance coverage remains to be seen, but if it continues on a path without a government option, nobody has any power to challenge the big money tanks.  Come to think of it, why didn’t the insurance businesses help bail out Wall Street, they certainly had the funds on hand with the rainy day or “reserves” on hand, that AIG was supposed to have.  It certainly would have taken much less of a toll on America and perhaps without such huge stashes of reserves they would not be so strongly in the driver’s seat today and it would have been business taking care of business instead of the government having to step in. 

Top officials for the American Medical Association and the American Hospital Association agreed yesterday that they should set aside their long adversarial history with health plans and work together, not for their own bottom lines, but to improve the health of their patients with by adhering to comparative effectiveness research.

“We need to fundamentally change the relationship between America’s health plans, physicians and hospitals,” said Thomas Priselac, chairman of the AHA board and president and CEO of Cedars Sinai Hospital in Los Angeles, who called for “a paradigm shift” in the structure of how they interact and how they share information.

Nancy Nielsen, MD, president of the AMA, agreed, saying interactions have been “wildly adversarial” between health plans and doctors “for much of recent history. We are all trying to change that.”

The health leaders made their comments in San Diego before an audience of several hundred attending the annual convention of America's Health Insurance Plans.  Nielsen added that it's the AMA’s highest priority to get health insurance coverage for every American. “The fact that we have not as a country been able to figured out how to have affordable health insurance for our citizens is a moral stain on this nation,” she said. “It is time that we fix it.”

AHA and AMA Ask Health Plans: Can’t We All Just Get Along? - www.healthleadersmedia.com

Related Reading:

How Similar is Wall Street to the Health Insurance Business

Concerned over Wall Street CEO Pay – How About Health Insurance CEOs?
Wall Street and Healthcare – Was it the Mob or have the rest of us been operating like a PC with no anti-virus protection?

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