Notes & Links: August 2, 2013

Read the Fine Print Before You Burn Your Obamacare Card

A guest post by Aaron Carroll on The Incidental Economist speaks to the conservative organizations pushing young adults to skip joining ACA and pay the penalty. 

People pushing young adults to skip the exchanges aren’t saying, “Don’t enroll now… but hey, if you get sick in a few months, we’ll understand if you have a change of heart.” They’re saying, “Don’t enroll now; pay the penalty instead. And if you fall ill, or become pregnant, or get stabbed while doing a good deed and you can’t buy a plan, well, them’s the breaks. That’s the gamble we asked of you.”

Some of these young adults must have seen their parents loose jobs, loose coverage, loose their homes, and life without healthcare coverage. I would think that is enough motivation to want healthcare insurance. It would be for me. I know when I had a bunch of employees working for me I made sure healthcare insurance was offered at a great price and for many many years with no employee contribution. I believed in its value. Hopefully these young adults see the value as well. We’ll know soon enough. 

Countdown to The Physician Sunshine Act: Gloomy Days Ahead

Jonathan Govette posting on HealthWorks Collective speaks to the Sunshine Acts and its August 1, 2013 start of data collection. The title kind of says it all about his position and attitude. And the site is sponsored by Siemens a medical device manufacturer. 

So basically every doctor in the country will now have to report his private financial information to the world.  Seems like this is a complete waste of time and will cause more harm than good.

I would agree about flashing personal income all over the web. But these are payments that have been well documented and associated with prescribing and often not associated with evidence based medicine or the best Rx for that patient. Patients and colleagues should know what the financial association with pharma or device manufactures are. That’s why they call it transparency. 

Sunlight as Disinfectant

Professor Meredith Rosenthal Ph.D. and Michelle Mello, J.D., Ph.D writing in the NEJM have a much better and more salient review of the Sunshine Act and its benefits vs. the problems. They capture two key point here:

Disclosure rules aim to influence the behavior of both the subjects of reporting and those making decisions about whether to do business with them. Thus, one mechanism through which the Sunshine Act could reduce health care costs is that patients, having learned of a physician’s involvement with industry, might alter their view of the physician’s trustworthiness. They might be less inclined to accept treatment recommendations from these physicians or even to receive care from them. Given the evidence that greater physician financial involvement with manufacturers is associated with higher utilization of expensive, brand-name products, such dynamics could reduce costs.

Experience gives reason for skepticism about the potential force of patients’ response to disclosures, however. Decades of public reporting of provider quality information have underscored the difficulty of engaging consumers in seeking even the most salient information about their providers, such as a cardiothoracic surgeon’s predicted mortality rate, from a passive report.3Consumers are typically unaware of these data and, even when they know about them, tend to choose their providers on the basis of other factors. The payment data are also complex, and even with the educational information CMS plans to provide, patients may have difficulty evaluating the undesirable and beneficial aspects of various types of payments.

Read both articles and see which one rings as a true well balanced examination of the Sunshine Act and which one is grinding a whinny ax?

Spike Lee Shares His NYU Teaching List of 87 Essential Films Every Aspiring Director Should See

Thanks to Doc Searls for this link. I would love to be an aspiring director but I am more of a film freak so I wanted to see what was on his list. I’ve seen 62 of the 87 and need to revisit most of them (memory sucks) besides what I haven’t seen. Guess me and Netflix will be busy this year.

You Don’t Have To Be A Data GeekTo Love Consumer Health Devices—But It Helps

David Shaywitz writing on writing about capturing health data from phones, devices, and apps. I think for some of us he captures what and why for these devices 

In other words, my gadgets don’t provide essential information I couldn’t get elsewhere, but they motivate me to pursue and sustain activities I might otherwise avoid – like regularly checking my blood pressure, or finding time for a run.  They facilitate data sharing, whether with my doctor, as I’ve described, or with friends and family who can offer encouragement and motivation

I agree because on my bike I have a HR monitor and a computer to capture speed, cadence, max and average speed. I just love the data and comparing one ride to another. I no longer make a spread sheet with it. Maybe I will start again. But the bigger question is who are the others that capture data? What do they do with it? Do they share it with their physician? To what end?

We need to know more about the new world of consumer data. 

Hamptonites Are All Smiles Over Newest House Call

For the fee of $999, more than double what it costs for services in their office, the husband-and-wife dental team of Dr. Jeffrey Rappaport and  Dr. Michelle Katz will perform professional teeth whitening in the comfort of a client’s living room.

The only thing that comes to mind here is “Qu’ils mangent de la brioche“. But we live in a free market for some.

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