It’s Time to Stop the Blame Game in Healthcare and Fix the Problems

Last week, as a nation, we saw the best and worst of ourselves as images from Charlottesville seared our conscience. Casting blame is easy. Solving underlying problems is much harder. That’s true in race relations. It’s true in healthcare.

The blame game in healthcare is a rich tradition. Each sector has sharpened its attacks on the other. Each believes in its moral superiority. Each believes solutions begin in acceptance of guilt and repentant actions by others. It’s a game we’ve played effectively and energetically for the past 40 years.

Our system is big, influential, complicated, and expensive but it is not a system. It is fragmented and incomprehensible to most. It works some of the time for most of the people. But at a cost that’s beyond the reach of growing numbers of families and individuals.

Our blame game is counter-productive.  Examination of root causes and honest dialogue are needed… why our human services and health programs are disconnected…why specialty medicine and primary care are not on equal footing…why individuals make unhealthy lifestyle choices…why healthcare investors make bets on short-term gains…why mental health is stigmatized. why unnecessary care is pervasive and rewarded…why insurance is no guarantee against financial ruin…why drugs and technologies cost more at home than elsewhere…why we the people are a muted voice in how the system operates…and more.

Like Charlottesville, there are innocent victims of our failure to move beyond the blame game in healthcare. It’s time to stop playing the blame game and solve the problems.

Though Congress was taking a break from DC last week, healthcare news was prominent:

  • CMS proposes suspension of mandatory bundles: Wednesday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to eliminate three mandatory bundled payment programs and scale back a fourth. Its proposal would cut the markets where hospitals are required to participate in the Comprehensive Care for Joint Replacement (CJR) model from 67 to 34 and allow low volume and rural hospitals to opt out reducing the number of participating hospitals from 800 to 393 and Medicare savings from the CCJR program from $294 million to $204 million. It also proposed canceling the mandatory Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) bundles scheduled to start January 1, 2018 in 1120 hospitals and the Surgical Hip and Femur Fracture Treatment (SHFFT) program in 860 hospitals. CMS administrator Seema Verma said the agency intends to replace these with voluntary bundles later.
  • Mylan agreement finalized: Mylan reached final agreement with prosecutors and will pay $465 million to resolve its False Claims Act suit that it withheld rebates due to Medicaid programs for its EpiPen, its injectable epinephrine used to treat severe allergies. Ironically, Sanofi, a drug manufacturer, will pocket $38.7million for blowing the whistle. The company agreed to a five-year monitoring program of its Medicaid compliance, and also said it would pay the higher rebate on EpiPen’s as of April 1, 2017. Meanwhile, Mylan has introduced an authorized generic version of the medication that the company says costs less than half the wholesale acquisition price of the brand name version. Note: Mylan raised the price of an EpiPen two-pack to $600 in 2016 from $100 in 2008. A May 2016 analysis by U.S. Department of Health and Human Services Office of Inspector General estimated that Mylan's Medicaid overcharges may have totaled $1.27 billion for 2006 through 2016.
  • Healthcare stocks volatile: Healthcare stocks in the S&P 500 rose 6.7% in the second quarter, double the 2.6% gain in the broad S&P 500 index. However, healthcare stocks have underperformed since the current quarter began on July 1, dipping 0.5% compared with a 1.9% gain by the broad S&P 500.
  • End of life counseling: In 2016, the first-year health care providers were allowed to bill for the service, nearly 575,000 Medicare beneficiaries, or 1% of Medicare beneficiaries, took part in 30-minute end of life discussions with their physicians, according to a government report released last week. Nearly 23,000 providers submitted about $93 million in charges, including more than $43 million covered by the federal program for seniors and the disabled. The program reimburses physicians $86 for the first 30-minute office visit and $75 for additional sessions.
  • Avoidable readmission results for 2016 unchanged from 2015: Medicare will penalize 2,573 hospitals up to 3% for avoidable readmissions in 2016 $564 million—essentially the same as 2015.  One in five Medicare patients ends up back in the hospital within 30 days, unchanged since 2012.
  • Hospice website available: The Centers for Medicare & Medicaid Services released Hospice Compare, a consumer-focused website that lets families compare up to three hospice agencies at a time, among 3,876 nationwide. Families can see how hospices performed in seven categories, including how many patients were screened for pain and breathing difficulties and how many patients on opioids were offered treatment for constipation. But measures of quality are self-reported lending to a not-surprising result: three-quarters of hospices scored at least 91% out of 100 on six of the seven categories.

We are fortunate to be part of an industry that’s essential to the wellbeing of every individual. It’s a big business for sure, but it’s much more.

Paul