The Healthcare Policy Podcast ® Produced by David Introcaso

Listen Now Despite signifcant press coverage over the past four and a half years many provisions of the Affordable Care Act remain largely unknown to the American public.  Polling data shows slightly less than half of Americans know the ACA is still law, over half said they've heard nothing about the state marketplaces and over a third do not know there's a penalty for not having health insurance....

Listen Now While it appears obvious a person's health status is directly related to their life circumstances the health care industry has been slow to recognize an individual's bio-psycho-social factors or characteristics in planning and delivering an individual's care.  This critcism is typically phrased as clinicians being over attentive to the "patient" and under attentive to the "person".  For...

Listen Now Half of the US adult population suffers one or more chronic illnesses and two-thirds of the Medicare population suffers three or more.  Largely for this reason, i.e., the prevalenece of chronic conditions, health care delivery, by necessity, is becoming ever increasingly more team based.   Providing care particularly for the chronically ill therefore places a premium on enhanced relatio...

Listen Now Despite recent efforts to improve care delivery for mental health and substance use conditions, for example, passage in 2008 of the Mental Health Parity and Addiction Equity Act, mental health and substance use conditions remain both woefully under-diagnosed and treated.  For example, one recent study of emergency department patients showed psychiatric illnesses were under-diagnosed in ...

Listen Now Health care insurance plans and policy makers are constantly working toward improving cost management.  Recently two techniques to do so have reemerged in this effort: narrow networks and reference pricing, techniques that have enjoyed success in the past.  Likely the largest (de facto) user of narrow networks is the integrated health plan Kaiser and CalPERS (the California Public Emplo...

Listen Now Medicare billing fraud is pervasive.  It's estimated at $50 to $60 billion annually or approximately 10% of all of Medicare spending.   While billing fraud is committed in numerous ways from never performed procedures to fake patient care, it's possibly no more prevalent than in home health care, an industry of 12,000 providers whom bill Medicare $18 billion annually.  For example, a 20...

Listen Now A few years ago the federal Agency for Healthcare Research and Quality sponsored billboard ads that stating simply "this year thousands of men will die from stubbornness."  The message was intended to encourage moreover middle age men to seek preventive health screening since they are 25 percent less likely than women to visit a doctor in any one year and 30 percent more likely to be ho...

Listen Now Late last year Gilead Sciences received FDA approval for its Hepatitis C drug Solvaldi.   Hepatitis C (Hep C) affects three to four million Americans and can have serious health consequences.  Gilead priced the drug at $1,000 a pill or between $84,000 and $168,000 for the full, curative treatment (effective in approximately 90% of patients).   However as priced if every Hep C patient re...

Listen Now As is well known Congressional Republicans have vehemently opposed the Affordable Care Act (the ACA or Obamacare). House Republicans, for example, have voted an estimated 50 times to replace the law.   Despite their criticisms over the past four years only recently has the party presented anything that approaches a substantive alternative to the ACA. Earlier this year an alternative pro...

Listen Now Primary care is considered the bedrock of healthcare delivery.   Primary care services promotes wellness, prevents disease onset, progression, exacerbation and premature death and moderates the need for higher-cost specialty services.   However, as the recent news about wait times at VA health care facilities demonstrated, the US suffers a shortage of primary care providers.  The curren...

Listen Now In May 2011 Vermont passed legislation signed by Governor Peter Shumlin creating a single-payer, publicly financed, universal health care system termed Green Mountain Care.  The law recognized health care as a public good much like electricity.  The program, not expected to go into effect until at least 2017, will be defined by an independent board, the Green Mountain Care Board, create...

Listen Now  The ACA's open enrollment period ended this past March 31st. Over eight million Americans signed up for health care insurance.  Of these 2.2 million, or 28 percent, were young adults or between the ages of 18 and 34.  In 26 states and the District of Columbia approximately 15 million adults with income below 138 percent of the poverty level became eligible for Medicaid coverage.  (19 s...

Listen Now This past April 24th the FDA announced a proposed rule to regulate e-cigarettes .  The FDA is, in part, proposing to ban the sale of e-cigarettes to minors, require manufacturers to disclose e-cigarette ingredients and prohibit manufacturers to claim e-cigarettes are less harmful than tobacco cigarettes without submitting scientific proof.  The proposed rule did not forbid TV advertisin...

Listen Now The 2010 Affordable Care Act created the Center for Medicare and Medicaid Innovation at CMS with $10 billion in funding to test innovation and service delivery models to improve health care delivery and outcomes and reduce costs.   To date the CMS Innovation Center has funded one round of innovation awards throughout the US (a second round of awards are expected to be announced this sum...

Listen Now Since the 1960s Community Health Centers (CHCs) have been providing health care services to moreover minority populations, the poor and the uninsured.  Today there are approximately 1,200 health centers providing health care to over 20 million Americans in all fifty states.  They our the nation's true safety net.  The Affordable Care Act created the CHC Fund that provided $11 billion ov...

Listen Now Since 1992 use of the RBRVS ( Resource Based Relative Value Scale ) has been the prevailing method by which physician procedure prices are determined.  The method or formula for determining prices is managed by the AMA's RUC (or the Relative Value Update Committee ).  In recent years the RUC has come under increasing criticism largely because their work perversely incents the use or ove...

Listen Now   Corporate Owned Life Insurance are life insurance policies corporations buy on their employees whereby the corporation is the named beneficiary.  This practice, at least initially, was adopted as a way of insuring a company against the loss of a limited number of key executives.  These policies also became attractive because both premium returns and benefits paid were not taxed.  Over...

Listen Now Concierge medicine (also termed membership medicine, direct pay or cash only practice) has become a rapidly-growing care model moreover among primary care physicians.  In concept, physicians charge patients a monthly or annual fee that can vary widely from approximately $50 per month to $25,000 per year (or accept cash only per visit).  In exchange patients are promised greater access,...

Listen Now The term "medical home" was first introduced in the 1960s by the pediatric profession.  Still to date this model of care emphasizes team-based comprehensive, continuous and coordinated care.   The care model is intended to improve primary care generally via improved patient communication, care quality, safety and outcomes.  In several ways the ACA encouraged the adoption of the, now ter...

Listen Now In late January in a case involving a Catholic charity, the US Supreme Court issuesd a ruling temporarily exempting religious-affiliated non-profits from providing ACA-required contraceptive coverage.  (The ACA coverage requirement was based on an IOM recommendation that found birth control is "medically necessary."  The requirement took effect January 1st).  While churches and houses o...

Listen Now (This podcast is a companion to the November 13th interview with Infectious Diseases Society of America's Amanda Jezek.)   As previously noted, conservative estimates show hospital-acquired infections (HAIs) alone sicken two million Americans, directly kill 23,000 and contribute to a total of 100,000 deaths each year.  The bacterial infection C. diff ( Clostridium difficile ) alone caus...

Listen Now  The Emergency Medical Treatment and Labor Act (EMTALA) was passed in 1986 under the Reagan administration to help prevent patient dumping.  The law requires hospitals to provide emergency medical treatment to anyone regardless of citizenship, legal status or ability to pay.  In recent years however hospitals have begun to impose upfront emergency room fees.  Today approximately half of...

Listen Now Of the two and a half million Americans that die annually, less than half, or 45%, die under hospice care. About one-third of these deaths are cancer related the remainder are moreover from heart and lung disease and dementia.  Of the over 5,000 hospice providers nearly two-thirds are for profit.  Over 80% of all hospice care is paid for by Medicare.  While hospice care is ever-increasi...

Listen Now  Transcendental Meditation (TM) has long been studied as an approach to improving health status generally and lowering blood pressure specifically.  For example, the American Heart Association published research in 2012 that found African Americans who practiced TM regularly over five years were almost half as likely to have a heart attack or stroke or die from all causes compared to Af...

Listen Now Human physiology or biological functioning exhibits fractal or irregular patterns.  When heart rate, (or respiration rate, blood pressure, brain waves and even walking stride length) begins to lose its fractal dimension or there is a loss of heartbeat variability, this is an indication of illness.  In order to respond best to environmental circumstances, adaptative variability (not home...