Monthly Archives: September 2012

Lisa Iezzoni’s new book on Risk Adjustment****

I just received and have scanned through Lisa Iezzoni’s fourth book (as editor and major contributor) entitled

Risk Adjustment for Measuring Health Care Outcomes (Fourth Edition), Lisa I Iezzoni (ed) (2013)

Even though Lisa is a physician, not an economist or statistician, this book provides an excellent overview of risk adjustment (population-based), and severity or case mix adjustment (episode or event based), and includes discussion of available datasets, model comparisons, propensity score matching, lists of information potentially useful, clinical classification, variables  clinical, social and statistical issues. Contributions on statistical methodology by Michael Swartz and Arlene Ash, as well as separate chapters on mental health, long term care, managing healthcare organizations, and provider profiling are excellent. Its main weakness is in not capturing international developments at all, not discussing the commercial market for risk adjustment models, and not covering most nonlinear and econometric (as distinct from statistical) issues well. Still, it should be required reading for anyone planning to do work in this area.

I have put it on my list of all time favorite books, but acknowledge that only a limited subset of people will be interested in it.

 

Comprehensive Primary Care Initiative, by CMS, Overview

CMS posted in late August an interesting site that provides lots of information about the seven demonstrations going on for Comprehensive Primary Care Payment.

http://innovations.cms.gov/initiatives/Comprehensive-Primary-Care-Initiative/index.html
Each site includes a list of participating PCPs. with specific clinic names, zip codes and addresses. Could be interesting to examine how severe a selection problem there is.

Five Questions for Health Economists

My presidential address to the American Society of Health Economists is now available to download and scheduled for publication in the International Journal of Health Care Finance and Economics. Here is the link.

Five questions for health economists

Randall P. Ellis

Online First™, 3 September 2012

Here is the direct link to the pdf file.

http://www.springerlink.com/content/7m2668027362x52r/fulltext.pdf

 

Stirring but informative Clinton nomination speech for Barack Obama

I highly recommend to you the YouTube link to Bill Clinton’s 49 minute Nominating Speech for Barack Obama.
Of particular use to health economists are his comments on the implications of the Romney-Ryan discussion of Medicare and Medicaid, I recommend that you watch the segment from 28:10 to 36:10.

http://www.youtube.com/watch?v=JeqNmaawCVw

Watch 28:10 to 36:10 to understand the health care discussion and why this issue is so important.
If you prefer text, you can read his speech as transcribed in the NYTimes.

The prepared text is linked here.

http://www.huffingtonpost.com/2012/09/05/bill-clinton-speech-text-_n_1850531.html?utm_hp_ref=elections-2012

The health discussion text from the speech follows. Note that his actual speech deviated from the prepared text in a few key places. Hence I am using the transcript.

Now, that brings me to health care. (Cheers, applause.) And the Republicans call it, derisively, “Obamacare.” They say it’s a government takeover, a disaster, and that if we’ll just elect them, they’ll repeal it. Well, are they right?

AUDIENCE MEMBERS: No!

PRESIDENT CLINTON: Let’s take a look at what’s actually happened so far.

First, individuals and businesses have already gotten more than a billion dollars in refunds from insurance companies because the new law requires 80 (percent) to 85 percent of your premium to go to your health care, not profits or promotion. (Cheers, applause.) And the gains are even greater than that because a bunch of insurance companies have applied to lower their rates to comply with the requirement.

Second, more than 3 million young people between 19 and 25 are insured for the first time because their parents’ policies can cover them.

(Cheers, applause.)

Millions of seniors are receiving preventive care, all the way from breast cancer screenings to tests for heart problems and scores of other things. And younger people are getting them, too.

Fourth, soon the insurance companies — not the government, the insurance companies — will have millions of new customers, many of them middle-class people with pre-existing conditions who never could get insurance before. (Cheers, applause.)

Now, finally, listen to this. For the last two years — after going up at three times the rate of inflation for a decade, for the last two years health care costs have been under 4 percent in both years for the first time in 50 years. (Cheers, applause.)

So let me ask you something. Are we better off because President Obama fought for health care reform? (Cheers, applause.) You bet we are.

Now, there were two other attacks on the president in Tampa I think deserve an answer. First, both Governor Romney and Congressman Ryan attacked the president for allegedly robbing Medicare of $716 billion. That’s the same attack they leveled against the Congress in 2010, and they got a lot of votes on it. But it’s not true. (Applause.)

Look, here’s what really happened. You be the judge. Here’s what really happened. There were no cuts to benefits at all. None. What the president did was to save money by taking the recommendations of a commission of professionals to cut unwarranted subsidies to providers and insurance companies that were not making people healthier and were not necessary to get the providers to provide the service.

And instead of raiding Medicare, he used the savings to close the doughnut hole in the Medicare drug program — (cheers, applause) — and — you all got to listen carefully to this; this is really important — and to add eight years to the life of the Medicare trust fund so it is solvent till 2024. (Cheers, applause.)

So — (chuckles) — so President Obama and the Democrats didn’t weaken Medicare; they strengthened Medicare. Now, when Congressman Ryan looked into that TV camera and attacked President Obama’s Medicare savings as, quote, the biggest, coldest power play, I didn’t know whether to laugh or cry — (laughter) — because that $716 billion is exactly, to the dollar, the same amount of Medicare savings that he has in his own budget. (Cheers, applause.) You got to get one thing — it takes some brass to attack a guy for doing what you did. (Laughter, cheers, applause.)

So — (inaudible) — (sustained cheers, applause) — now, you’re having a good time, but this is getting serious, and I want you to listen.

(Laughter.) It’s important, because a lot of people believe this stuff.

Now, at least on this issue, on this one issue, Governor Romney has been consistent. (Laughter.) He attacked President Obama too, but he actually wants to repeal those savings and give the money back to the insurance company. (Laughter, boos.)

He wants to go back to the old system, which means we’ll reopen the doughnut hole and force seniors to pay more for drugs, and we’ll reduce the life of the Medicare trust fund by eight full years. (Boos.)

So if he’s elected, and if he does what he promised to do, Medicare will now grow (sic/go) broke in 2016. (Boos.) Think about that. That means, after all, we won’t have to wait until their voucher program kicks in 2023 — (laughter) — to see the end of Medicare as we know it. (Applause.) They’re going to do it to us sooner than we thought. (Applause.)

Now, folks, this is serious, because it gets worse. (Laughter.) And you won’t be laughing when I finish telling you this. They also want to block-grant Medicaid, and cut it by a third over the coming 10 years.

AUDIENCE MEMBER: No!

PRESIDENT CLINTON: Of course, that’s going to really hurt a lot of poor kids. But that’s not all. Lot of folks don’t know it, but nearly two-thirds of Medicaid is spent on nursing home care for Medicare seniors — (applause) — who are eligible for Medicaid.

(Cheers, applause.) It’s going to end Medicare as we know it. And a lot of that money is also spent to help people with disabilities, including — (cheers, applause) — a lot of middle-class families whose kids have Down’s syndrome or autism or other severe conditions. (Applause.) And honestly, let’s think about it, if that happens, I don’t know what those families are going to do.

So I know what I’m going to do. I’m going to do everything I can to see that it doesn’t happen. We can’t let it happen. (Cheers, applause.) We can’t. (Cheers, applause.)