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The Economics of Financing Medicare

Katherine Baicker, Ph.D., and Michael E. Chernew, Ph.D.

…so, yeah. We tend to use the tools we have on hand. Excel is not a first-rate page layout application, but it works and is ubiquitous and it is capable of rendering surprisingly attractive documents given a little effort. Whether your need is for a presentation or something else, feel free to use the attached .xls as a guide for:

• those confusingly arbitrary row height and column width numbers
• color palette selections
• font sizes (as far as size goes, 12 pt calibri ≠ 12 pt tahoma)

Printable guide linked below:

http://hefel.files.wordpress.com/2010/12/excel-formatting.xls

http://www.amazon.com/Street-Fighting-Mathematics-Educated-Guessing-Opportunistic/dp/026251429X

An earlier version is available for free download at MITOpenCourseware.

The MITOpenCourseware site for the course:

18.098 / 6.099 Street-Fighting Mathematics / As taught in: January IAP 2008

http://ocw.mit.edu/courses/mathematics/18-098-street-fighting-mathematics-january-iap-2008/readings/

The PDF itself:

http://ocw.mit.edu/courses/mathematics/18-098-street-fighting-mathematics-january-iap-2008/readings/sf_math.pdf

Survey shows health executives’ top 3 priorities for 2010-11

This is definitely getting printed on heavyweight 11×17.

Update: Make your own at this site.

http://www.deloitte.com/view/en_GX/global/insights/focus-on-the-issues/dcc690a7aacd6210VgnVCM100000ba42f00aRCRD.htm

Now available online: Deloitte 2010 Survey of Health Consumers. It covers the following countries:

• Canada
• France
• Germany
• Switzerland
• United Kingdom
• United States (alternatively, download the PDF)

The Mypressi Twist (filled with hot water from the stove and pressurized by a  nitrogen cartridge):

• http://mypressi.com/

Reviewed by T Magazine / Oliver Strand:

• http://tmagazine.blogs.nytimes.com/2010/02/18/ristretto-a-new-twist-on-espresso/?scp=1&sq=mypressi&st=Search

A distant hope for long-term returns or vague calculations …don’t seem to carry the day in hospitals and clinics facing large and immediate financial losses.-Don Berwick (IHI, CMS)

What’s measured improves. -Peter Drucker

So much of health adminstration is a struggle to understand what is happening internal and external to the organization, without ever having a very good grasp of the precise numbers…or even of the validity of the numbers. It’s the easiest thing to accidentally compare apples and oranges…

This post is intended to be a living list of the most relevant data sources for current and future health administrators. Focus is given to marketing, public health, and workforce statistics–but consideration will also be given to “thought frameworks,” libraries, and other types of databases.

Feel free to recommend a source by commenting below and I’ll update accordingly!

FREE DATA SOURCES

Agency for Healthcare Research and Quality (AHRQ/HHS, US)
Medical expenditures, cost, and utilization; hospitalizations; disparities; quality; HIV; grants.
http://www.ahrq.gov/data/

AHRQ HCUP (HHS, US)
Healthcare cost and utilization project. Utilization of healthcare services with special attention to ambulatory care, ED, and other select topics.
http://www.ahrq.gov/data/hcup/

AHRQ MEPS (HHS, US)
MEPS is the most complete source of data on the cost and use of health care and health insurance coverage.
http://www.meps.ahrq.gov/mepsweb/

AHRQ NHDR (HHS, US)
National healthcare disparities report. Access data for quality of health care, access to health care, or for priority populations.
http://nhdrnet.ahrq.gov/nhdr/jsp/nhdr.jsp

National Center for Health Statistics (CDC, US)
Vital statistics, health care consumption, infrastructure, behavior surveys.
http://www.cdc.gov/nchs/

CDC Publications and Info Sheets (CDC, US)
http://www.cdc.gov/nchs/data/infosheets/infosheet_summary.htm

MedLine Plus Health Statistics (National Library of Medicine/NIH, US)
Simplified and appropriate for laypeople. Focuses on conditions and vital stats, but also includes links to other relevant databases.
http://www.nlm.nih.gov/medlineplus/healthstatistics.html

AgingStats (Agency on Aging, US)
http://www.agingstats.gov/agingstatsdotnet/main_site/default.aspx

Kaiser Family Foundation Stats (KFF, US)
Stats and reports on costs, insurance markets, uninsured, and much more.
http://www.kff.org/

Robert Wood Johnson Foundation Publications and Reports (RWJF, US)
http://www.rwjf.org/pr/

The Commonwealth Fund (US)
Maps, data, surveys, and meta-analyses relevant to health policy topics.
http://www.commonwealthfund.org/

NCQA Health Plan Report Card (NCQA, US)
http://reportcard.ncqa.org

USNews Best Health Plans
http://health.usnews.com/directories/health-plans/

NCQA HEDIS Quality Statistics (NCQA, US)
The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service.
http://www.ncqa.org/tabid/59/Default.aspx

Social Security Administration Budget and Performance Reports
http://www.ssa.gov/pgm/links_governance.htm

OMB Statements and Releases (White House, US)
http://www.whitehouse.gov/briefing-room/statements-and-releases

WHOSIS Global Health Statistics (WHO, Int’l)
An interactive database bringing together core health statistics for the 193 WHO Member States. It comprises more than 100 indicators.
http://www.who.int/whosis/en/

Cancer Trends Progress Report (NCI/NIH, US)
The report includes key measures of progress along the cancer control continuum and uses national trend data to illustrate where advances have been made.
http://progressreport.cancer.gov/

State Cancer Profiles (NCI/NIH, US)
Dynamic views of cancer stats for prioritizing cancer control efforts at the state level.
http://statecancerprofiles.cancer.gov/

UNStats (UN, Int’l)
Demographics and social concerns (disabilities, housing, welfare, disease) from participating global nations.
http://unstats.un.org/unsd/demographic/default.htm

ASPE Gateway to Data and Statistics (HHS, US)
Housing, risk factors, outcomes, disease, lost work days, spending.
http://www.hhs-stat.net/

SEER (NCI/NIH, US)
In-depth cancer statistics for the US.
http://seer.cancer.gov/index.html

American FactFinder (Census Bureau, US)
Demographics
http://factfinder.census.gov/home/saff/main.html?_lang=en

Topic: Health Insurance (Census Bureau, US)
http://www.census.gov/hhes/www/hlthins/hlthins.html

Data.gov (White House, US)
Everything…in multiple formats (.xls, .csv, .txt)…searchable.
http://www.data.gov/

HRSA HPSAs (HHS, US)
Health professional shortage areas.
http://hpsafind.hrsa.gov/

HINTS (NCI/NIH, US)
Health information survey results–perceptions, mental models of cancer, patient education outcomes, communications.
http://hints.cancer.gov/questions/index.jsp

Kaiser Family Foundation State Health Facts (KFF, US)
http://www.statehealthfacts.org/

State Scorecards (Commonwealth Fund, US)
View state-specific rankings and results compared to benchmarks, and to view the number of lives and dollars each state could save by achieving benchmark levels of performance
http://www.commonwealthfund.org/Maps-and-Data/State-Scorecard-2009.aspx

NHQR State Snapshots (AHRQ/HHS, US)
The State Snapshots provide State-specific health care quality information, including strengths, weaknesses, and opportunities for improvement. The goal is to help State officials and their public- and private-sector partners better understand health care quality and disparities in their State.

http://statesnapshots.ahrq.gov/snaps08/index.jsp

America’s Health Rankings (APHA et al, US)
State-by-state comparisons.
http://www.americashealthrankings.org/

National Resource Center: Health Information Technology (AHRQ/HHS, US)
Access project-specific information on the AHRQ health IT portfolio.
http://healthit.ahrq.gov/portal/server.pt?open=512&objID=650&parentname=CommunityPage&parentid=5&mode=2&in_hi_userid=3882&cached=true

NLM Reference: Disparities and Minority Health
Citations to journal literature, combining subject terms and title & abstract words on the topic.
http://www.nlm.nih.gov/services/health_disparities.html

Medicare Part D Claims Data (CMS, US)
http://www.cms.gov/PrescriptionDrugCovGenIn/08_PartDData.asp

Bureau of Labor Stats: Injuries, Illnesses, and Fatalities (BLS, US)
http://www.bls.gov/iif/

“CDC STATE” Tobacco Activities Tracking (CDC, US)
http://apps.nccd.cdc.gov/statesystem/Default/Default.aspx

Vaccine Safety Info and Stats (CDC, US)
http://www.cdc.gov/vaccinesafety/index.html

NHSN National Healthcare Safety Network (CDC, US)
http://www.cdc.gov/nhsn/

Traffic Fatalities and Accident Statistics (NHTSA, US)
http://www.nhtsa.dot.gov/people/ncsa/

KFF Global Health Facts (KFF, US)
http://globalhealthfacts.org/

CMS Physician Quality Reporting Initiative (CMS/HHS, US)
http://www.cms.gov/pqri/

CMS Physician Fee Schedule Lookup (CMS/HHS, US)
http://www.cms.gov/pfslookup/

CMS National Health Expenditure Data (CMS/HHS, US)
http://www1.cms.gov/NationalHealthExpendData/

USNews Best Hospitals (USNWR, US)
http://health.usnews.com/best-hospitals

American Hospital Directory (only partially free) (AHD, US)
http://www.ahd.com/

Hospital Compare (HHS, US)
http://www.hospitalcompare.hhs.gov

JC Accreditation Quality Check (JC, formerly “JCAHO”, US)
http://www.qualitycheck.org/consumer/searchQCR.aspx

National Report Card on the State of Emergency Medicine (US)
http://www.emreportcard.org/

ThomsonReuters Top 100 Hospitals
http://www.100tophospitals.com/

American Cancer Society Cancer Facts and Figures (ACS, US)
http://www.cancer.org/docroot/stt/stt_0.asp?from=fast

American Heart Association Statistics (AHA, US)
http://www.americanheart.org/presenter.jhtml?identifier=1200026

WHO ICD-10 Online (WHO, Int’l)
http://www.who.int/classifications/icd/en/

CMS DRG PC Pricer Software
http://www.cms.gov/PCPricer/

AMA Non-Commercial CPT lookup
https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp

Chrisendres’ CPT lookup
http://icd9cm.chrisendres.com/

CMS Public-Use Provider Specific Facts
Details on adjustments to PPS system.
http://www.cms.gov/ProspMedicareFeeSvcPmtGen/03_psf_text.asp

Institute for Healthcare Improvement Improvement Topics (IHI, US)
http://www.ihi.org/ihi/topics

12manage
Management frameworks and encyclopedia.
http://www.12manage.com/start_page.asp

PubMed (NCBI/NLM/NIH, US)
http://www.ncbi.nlm.nih.gov/pubmed

Managed Care Digest Series (Sanofi/Aventis, US)
http://www.managedcaredigest.com

…if you can’t find it in the list above, try looking at another list:

http://phpartners.org/health_stats.html

SUBSCRIPTION-BASED ACCESS

University HealthSystem Consortium

https://www.uhc.edu/

Association of American Medical Colleges

http://www.aamc.org/

American Hospital Association

http://www.aha.org/

NielsenClaritas PRIZM Consumer Behavior Segments

http://www.claritas.com/MyBestSegments/Default.jsp

SBI Values and Lifestyle VALS survey

http://www.strategicbusinessinsights.com/vals/presurvey.shtml

MGMA Physician Compensation Survey

http://www.mgma.com/PhysComp/

Billian’s  HealthData: “The Hospital BlueBook” (US)

https://www.hospitalbluebook.com/

Available online: http://news.yahoo.com/s/ap/20100413/ap_on_he_me/us_med_dr_nurse

It’s a nice discussion (for AP, anyway) of the controversy surrounding DNPs (Doctors of Nursing Practice) and their inevitable entry into the world of primary care. (Please do ignore the comments section, as people apparently love to demonstrate their ignorance of the topic with vitriolic, rambling, partisan outbursts.)

Even doubling the current enrollment in DNP programs, this will take a long time to make a dent–perhaps nearly as long as it would take if we were to increase allopathic enrollment tomorrow. Hospitals and systems (and states…) will simply have to find a way to do more work with less staff.

I had the chance to do quite a bit of research on this topic for several classes while in the MHA program at the U of Iowa. For more resources on the efficacy and effectiveness of DNPs in this role, see the following articles:

“Making Room for Dr. Nurse”

WSJ

Laura Landro (April 2, 2008)

http://online.wsj.com/public/article_print/SB120710036831882059.html

Although there are no precise statistics on the number of nurses with doctorates because the programs are relatively new, there are about 1,874 DNP students currently enrolled in programs nationwide, up from 862 students in 2006, according to the American Association of Colleges of Nursing.

Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial.

Mundinger et al. JAMA. 2000 Jan 5;283(1):59-68.

http://jama.ama-assn.org/cgi/content/full/283/1/59

In an ambulatory care situation in which patients were randomly assigned to either nurse practitioners or physicians, and where nurse practitioners had the same authority, responsibilities, productivity and administrative requirements, and patient population as primary care physicians, patients’ outcomes were comparable.

The ABCs of the Doctor of Nursing Practice: Assessing Resources, Building a Culture of Clinical Scholarship, Curricular Models

Mundinger et al. J Prof Nursing. Vol 25, Issue 2. 69-74. March 2009.

http://www.professionalnursing.org/article/S8755-7223(08)00023-9/abstract

The Council for the Advancement of Comprehensive Care has met since 2000 to build consensus on competency standards and a process for certifying these graduates. Deans of five nursing schools discuss their experiences and provide guidance for schools interested in developing DNP programs.

&nbsp

→ Contact me for more references on the topic.

by FREAKONOMICS

Jennie E. Brand and Yu Xie find that the unlikeliest male college graduates earned 30% more over their lifetimes than comparable men who earned only a high school degree. In contrast, male college graduates most likely to go to college earned only 10% more than their non-college-educated counterparts.  Brand and Xie observed a similar trend for women.  The authors believe that the tough labor market faced by non-college-educated, disadvantaged students partly explains the results, but they point to an additional factor: economic motivation. “For students from disadvantaged groups, college is a novelty that demands economic justification,” Brand said. “By contrast, for students from advantaged backgrounds, college is a culturally expected norm. Economic gain is less of a motivation.”

http://www.asanet.org/images/journals/docs/pdf/asr/Apr10ASRFeature.pdf

How is this a surprise? In situations where a degree becomes the cultural norm, one is able to study music or art or any other humanity that promises little benefit in income increases. Forcing someone to make a self-interested choice with regard to career prospects improved through a degree improves income outlooks.

Like everything human, it comes back to incentives.

Of course, there are always those strange, idealist, irrationally-motivated folks that choose to study things like art…

Here’s a nice monday morning read–Clay Shirky‘s “The collapse of complex business models”

from http://www.shirky.com/weblog/2010/04/the-collapse-of-complex-business-models/

It would be easy to regard this as short-sighted on their part, but that ignores the realities of culture. For a century, ATT’s culture had prized—insisted on—quality of service. Their HR Department worked to identify potential employees who would be willing to cut corners, but the point of identifying those people was to avoid hiring them. The idea of getting into a business where those would be the ideal employees was heresy. ATT, like most organizations, could not be good at the thing it was good at and good at the opposite thing at the same time. The web hosting business, because it followed the “Simplicity first, quality later” model, didn’t just present a new market, it required new cultural imperatives.

“Solvated Electron in Organic Chemistry Laboratory”

http://pubs.acs.org/doi/abs/10.1021/ed800093n

“How Physical Attractiveness and Endorser-Product Match-up Guide Selection of a Female Athlete Endorser in China”

http://www.informaworld.com/smpp/content~db=all~content=a919912951

http://www.kaiserhealthnews.org

A description from their site:

Kaiser Health News (KHN) is a nonprofit news organization committed to in-depth coverage of health care policy and politics.

KHN’s mission is to provide high-quality coverage of health policy issues and developments at the federal and state levels. In addition, KHN covers trends in the delivery of health care and in the marketplace.

Among our goals: provide new opportunities for health care journalists to produce in-depth work and a new vehicle to distribute it through collaborations with major news organizations and on this Web site. This Web site also features daily summaries of major health care news from across the nation, as well as original videos and a broad range of commentary from contributing writers and issues.

KHN is a major program of the Kaiser Family Foundation, a non-profit private operating foundation, based in Menlo Park, Calif., dedicated to producing and communicating the best possible analysis and information on health issues.

“…a preliminary analysis of H.R. 3962, the Affordable Health Care for America Act…”

(PDF)

http://www.cbo.gov/ftpdocs/106xx/doc10688/hr3962Rangel.pdf

…and the text of the bill itself, for those of you who have plenty of time on your hands:

http://docs.house.gov/rules/health/111_ahcaa.pdf

What do providers need to start preparing for?

Here is my opinion about the core elements of the 5 bills presently in the Senate and House and what it may mean for doctors and hospitals

by John S. Toussaint, MD
President and CEO, ThedaCare Center for Healthcare Value. He writes:

…I would estimate that a 2-5% productivity improvement (depending on inflation) per year is the minimum to survive financially moving forward…

Those of you who have worked in hospitals or insurance understand the magnitude of that statement and the difficulty that organizations will have realizing that sort of sustained improvement. I had the pleasure of meeting this individual both during a symposium in Iowa City in 2007 and during a site visit last year at the ThedaCare in Appleton, WI. Even more impressive than Toussaint’s dedication to performance improvement was the level of staff buy-in. World class.

Find more about his recent article in Health Affairs here:

http://www.createhealthcarevalue.com/blog/post/?bid=10

Barnes and Noble Nook. Powered by Android, so apps are a possibility in the future…plus Wal-Mart’s now pricing books at $9.99, so titles should drop in price in the future. DRM details are sketchy and Apple’s supposed to be making a tablet, so I’ll wait this one out until more details emerge–but there’s no doubt it’s a much more exciting device than the Kindle.

http://googleresearch.blogspot.com/2009/06/google-fusion-tables.html

Before:

After:

…plus lots of collaboration functionality. It’s apparently very slow to compute with large data sets, but I can’t wait to see where this goes. It should be great!

http://health.scribemedia.org/2008/01/17/chw-medical-tourism-bumrungrad-international/

…from HealthDot.org (scribemedia): Ruben Toral sits down with Curtis Schroeder, CEO Bumrungrad International, a Bangkok Thailand hospital that has been around for 28 years and was one of the early movers in medical tourism.

http://www.medtripinfo.com/audio/by/title/interview_with_bumrungrad_s_group_ceo_curt_schroeder

…from MedTripInfo.com: Interview with Bumrungrad’s Group CEO, Curt Schroeder (Posted December 4th, 2007 by David Williams)