Vita Advisors

Health Reform and Part-time Workers

Kevin Roche — Fri, 24 May 2013 14:31:12 +0000

One of the major unintended, though completely predictable, consequences of the health reform law is employers moving workers to part-time status to avoid either providing insurance or paying a penalty for them. An Employee Benefit Research Institute report explores the trend. (EBRI Report) The law requires that if you have 50 or more full-time workers you have to provide health coverage or pay a penalty. So do you think a lot of small employers are either making sure they don’t get over that number or reducing full-time employees until they are under that magic number? Based on the Census Bureau’s Current Population Survey, the report finds that part-time workers are increasing and their health coverage is getting worse. Part-time workers weren’t getting much coverage anyway, in 2012 only 28% of employers with 3 to 199 employees provided health insurance to part-timers. In 2011, the likelihood that a person had coverage based on their own job was 60% for full-time workers but only 16% for part-time ones and the trend has been rapidly downward for part-timers. They also have had a falling likelihood of having coverage as a dependent. The percent of workers employed part-time had risen to 22.2% in 2011, and based on monthly employment numbers reported by the Bureau of Labor, has likely climbed significantly since then. The coupling of more part-time workers with less availability of coverage, and when coverage is available to part-timers it likely offers relatively low benefits and high costs. One consequence is that more people may be looking for subsidized individual coverage or Medicaid, which will raise the public dollars flowing out under this wonderful new health “reform”.

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Kevin Roche — Thu, 23 May 2013 20:01:38 +0000

UnitedHealth Group, Aetna and Cigna have all decided not to participate in California’s health insurance exchange, limiting the possibility of additional competition in California’s highly concentrated small group and individual market.

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Kevin Roche — Thu, 23 May 2013 12:36:46 +0000

ConsultingMD received $10 million dollars in a financing round led by Venrock, with the proceeds going toward expansion of its online network linking consumers to doctors.

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Kevin Roche — Thu, 23 May 2013 12:33:36 +0000

A survey from the American Action Forum suggests that only about 65% of younger Americans would not buy health insurance if premiums rose as much as 20%, but it is unclear that they understand whether or not they would be eligible for subsidies.

Reasons for Health Spending Growth

Kevin Roche — Thu, 23 May 2013 12:00:19 +0000

We all know that health spending in the United States has grown, a more interesting question is why, as the answer to that question will help design initiatives to control spending growth. Research published in Health Affairs examines factors in health spending growth over the period 1987 to 2009 for both the Medicare and Commercial populations. (HA Article) The authors begin by noting that early working looking at cost rises from 1940 to the 1990s noted demand side factors like a phenomenal growth in the number of people with insurance, health technology advances and income growth. From 1987 to 2009, however, there was little change in the number of people with coverage and some recent research suggest lower correlation between income and health spending. The authors focus on two factors, the prevalence of treated disease, which may include over-diagnosis, and the increase in spending per treated case. Note that the authors’ analysis is not per capita, but total health spending oriented and is based on survey data. And while the authors try to hold spending constant for inflation, they do not appear to discriminate between the unit price and the utilization components of spending per case. The study finds that about 51% of the spending increase is due to higher treated disease prevalence and about 39% to higher spending per case, thus accounting for almost all of the increase. For Medicare, 78% is due to greater disease prevalence and 14% to higher per case spending, while for commercial insurance the figures are 33.5% and 54%. This reflects the ability of Medicare to control reimbursement by fiat, while private payers are likely doing a good job on utilization control but losing pricing leverage vis-a-vis providers. A number of common diseases account for much of disease prevalence growth and obesity is said to be responsible for 22% of the spending increase. As the authors point out, strategies to reduce spending need to be heavily focused on these aspects of spending growth.

Comparative International Use of HIT

Kevin Roche — Wed, 22 May 2013 12:00:17 +0000

Accenture surveyed 3700 physicians in eight countries to find out how progress is coming on the miracle cure of health information technology. (Accenture Report) Use of both electronic medical records and health information exchange across providers appears to be increasing. The number of doctors who said they routinely access clinical data about a patient from another organization has risen to 47% in 2012 from 33% in 2011. Ninety-one percent of physicians said they are active users of EMRs in their care of patients. An increase in the number of physicians who receive testing results electronically was also reported in most countries. E-prescribing grew from 18% of doctors in 2011 to 21% in 2012. The United States shows some of the most dramatic gains, which is to be expected given the incentives and potential penalties related to HIT use. Across all countries usage tends to be highest for basic clinical patient note taking and administrative processes and relatively low for electronic communications with patients or other clinicians. Spain has one of the highest penetration rates across all uses, along with Singapore, and the United States is actually near the top as well. Younger doctors tend to be more “digital”, as are those in multi-specialty practices. Doctors tend to see the benefits of HIT as a reduction in medical errors and better quality of treatment decisions, but don’t agree as widely that HIT improves access or reduces unnecessary procedures or treatments.

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Kevin Roche — Wed, 22 May 2013 11:37:15 +0000

In an apparent bit of good news regarding reform implementation, it appears that premiums for plans sold on the insurance exchange in Washington State may go down from current rates, but Washington already is a highly regulated individual insurance market.

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Kevin Roche — Wed, 22 May 2013 11:33:28 +0000

According to survey research published in the Journal of the American Medical Informatics Association, hospital ER workers spend an astounding amount of their work time on Facebook, and actually spend more time on it when the ER is busier. Think there might be an opportunity for productivity improvement there?

Deloitte Physician Survey

Kevin Roche — Tue, 21 May 2013 12:00:05 +0000

Physicians remain the linchpin of the American health system, since they control access to many services. How they feel about the health system and their situation is therefore important. A Deloitte Center for Health Solutions survey took stock of current attitudes on a number of subjects. (Deloitte Survey) Most doctors, 70%, are satisfied with practicing medicine, with satisfaction higher among specialists and younger physicians. The most satisfying parts of their work are patient relationships and the promotion of health among patients. The least satisfying are long hours and less time for each patient. Almost 60%, however, express concern about the future of the health system and medicine and think many doctors may retire early. Doctors generally believe ACOs have some ability to improve care and in general find a tradeoff between more economic security working in large organizations and clinical autonomy in smaller practices. Almost half of physicians expect their income to decrease as a result of the reform law. Most expect the reform law to continue to be rolled out as planned, with largely negative consequences. Doctors are concerned about Medicare reimbursement and many would limit seeing Medicare beneficiaries if reimbursement does not improve. Generally they expect the trend toward consolidation with larger health systems to continue. More so than other surveys, this one suggests that most doctors are satisfied with their EHRs, but largely because of improved billing and time savings through e-prescribing, as well as better care coordination. Most doctors believe patient lifestyles have a major effect on health costs, and they think that properly designed incentives can help encourage wellness activities.

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Kevin Roche — Mon, 20 May 2013 15:48:41 +0000

Quest Labs has purchased the lab capabilities of Concentra, owned by Humana, and secured an exclusive contract to provide lab services for its clinics.