BLIS Congratulates President Obama on re-election and supports renewed focus on reform

I would like to congratulate President Obama on his reelection and commend Mitt Romney for the effort he put forth in this election.  While the process can be difficult for all of us at times it is nonetheless historically significant at how we Americans routinely will seamlessly transfer power and control of our government.  Business and government leaders have already put the election process behind them and are focusing on the issues at hand.

No single segment of America represents this better than the healthcare industry.  Read the attached news article for examples of how healthcare leaders are moving on.  “It didn’t really matter to us who won. We’re marching toward healthcare reform and the things needed to really transform healthcare in the United States,” said Mr. James Merlino, Chief Experience Officer at the Cleveland Clinic in Ohio, in an exclusive interview with FierceHealthcare.

  Merlino noted that when you really boil down the candidates’ healthcare platforms, Republicans and Democrats were aiming for the same thing.  “When you look at the platforms and the issues for both sides, they’re very similar in what needs to be done in the system.  I don’t think anyone would disagree that we have an expensive system; we need to take costs out.  We have a lot of uninsured patients; we need to make sure we’re delivering care to them. The basic issues are the same.”

Well said Mr. Merlino.  I couldn’t agree more.

The Importance of Selecting a Quality Plastic Surgeon

In an unfortunate but ‘sign of the times’ news story, plastic surgeons in Sarasota, Florida are banding together to help protect patients from other doctors.  According to Donna Koehn of the Herald-Tribune in Sarasota, 12 plastic surgeons have formed a new alliance to help inform plastic surgery patients about the risks of surgery and the importance of selecting the right plastic surgeon.  It seems that in Sarasota, Florida (a bastion of the well to do of ‘retirement age’), plastic surgery procedures are being performed by physicians who have little or no training in plastics.  As a result they are seeing patients in their offices who are suffering from the after effects of post-surgical complications that require medical attention.

Paying for surgery isn’t like buying a piece of furniture.  It is vitally important that patients take the time to understand the risks associated with the plastic surgery procedures they are considering having done.  Once they understand the risks patients need to understand that not all surgeons are created equal.  Only the best surgeons should be considered for these types of procedures.  Even then complications can occur.  How does a patient find the best surgeons?  A great place to start is the American Society of Plastic Surgeons website.  Only those plastic surgeons who have had at least six years of surgical training, have passed oral and written exams, and operate only in accredited medical facilities are members.  The ASPS website offers a host of helpful information for patients in addition to help finding ASPS member surgeons.

I applaud the efforts of these 12 plastic surgeons in Sarasota and hope that they can be successful in helping to educate patients.  Patients have to do their part in recognizing the value and importance of selecting the right surgeon and not just looking for the best price.  Every day I am talking to patients and helping them understand the risks of surgery and the value of selecting a qualified surgeon.  It may be a trite old statement, however it’s never been more true that ‘quality doesn’t cost – it pays’!

Study Suggests No Marginal Difference for Bariatric Complication Rates at COE vs Non-COE Facilities

Dr. Dimick and his colleagues at the University of Michigan are reporting an improvement in bariatric surgery complication rates following the Medicare decision to add coverage for bariatric surgery in 2006.  I am not surprised to see complication rates improve as surgeons perform more cases.  It has long been proven true that as bariatric surgeons perform more cases their complication rates improve.   In fact most insurers, including BLIS will require a certain minimum number of bariatric cases to have been performed by the surgeon applicant in an effort to ensure they are through the ‘learning curve’.

What is surprising in the Michigan study is the reference to Center of Excellence.  According to Dr. Dimick their data suggests there is no benefit to Medicare when the procedure is performed at a Centers of Excellence facility.  “Improvements in the safety of bariatric surgery did not, however, result from patients being redirected to safer hospitals.”, said Dr. Dimick.  In fact, complication rates for procedures performed at Centers of Excellence versus non–Centers of Excellence were not significantly different (odds ratio for any complications, 0.97), he noted.  His conclusions are consistent with our own data.  In the BLIS dataset there is no marginal difference between a COE designated BLIS surgeon vs one who is not.  It should be noted however that all BLIS surgeons are ‘COE eligible’ which means they all have demonstrated a certain level of procedure volume that would essentially mimic COE requirements.

Hopefully Dr. Dimick can be successful in expanding the Michigan registry and the scope of his study.    It would be  interesting to see how the results compare over time.  It would be even more helpful if they could track the cost of the complication events.  I’ll continue to monitor their activity and provide my commentary here.

Plastic Surgery Risk: From the Surgeon’s Perspective

Always on the lookout for how surgeons are communicating about risk with their patients, I recently began following the blog comments of Dr. Rian A. Maercks, a Miami plastic surgeon. I happen to think he has a terrific blog.  In his recent post about chin implants, Dr. Maercks states, “Complications are part of any plastic surgery practice. We used to say there are only three types of surgeons that don’t have complications, those that don’t operate, those that do not see their post-operative patients, and those that lie. It is simple statistics even in the best of hands, things happen.”

That’s a strong statement and one which I hope patients will pay attention to.    There are many things we can shop for to find a good bargain.    Plastic surgery isn’t one of them.    Every day, BLIS is paying medical bills that would otherwise have been a patient’s responsibility – and we are working with the best of the best surgeons.

A friend of mine is a top notch lawyer specializing in defending physicians in court when they are being sued for malpractice.    He’s been doing this for 20 some years and is really good at it.    A few years ago, his wife was diagnosed with a severe form of cancer and required a surgical procedure.     My friend sent an email around to a number of physicians, nurses and lawyers that he respected locally and asked them to list the top ten surgeons in the specialty that his wife required.    When the lists came back one name was consistently in the top 3 or 4 on everyone’s list.    Guess where his wife went for surgery?

We’ll continue to follow Dr. Maercks blog for you and comment whenever something important comes along.

Changing How Hospitals Are Paid For Complications

I read with great interest the study just published in HealthAffairs, “The Impact On Hospitals Of Reducing Surgical Complications Suggests Many Will Need Shared Savings Programs With Payers”.    After all I’ve spent much of my career dealing with the effects of surgical complications.    Every day I work with surgeons and their patients trying to help manage expectations and then dealing with the after effects of a complication when they occur.

From my perspective the issues surrounding a post-surgical complication event represent the most challenging aspect of how to reform our healthcare system.   Consider some of the dynamics involved.    For example, can you think of any industry that has historically generated more revenue and more profit from what most people would consider a ‘mistake’?   Let’s start there for now.    Is a post-surgical complication event a ‘mistake’?    In healthcare we distinguish a ‘complication’ from a ‘mistake’ by defining events following surgery as either ‘known risks’ or not.   If something happens that we know can occur then it is a ‘complication’.   If something happens that we know shouldn’t then it’s a mistake or what we refer to as an ‘adverse event’ or what is commonly thought of as a malpractice event.

I once had a professional healthcare risk manager describe the risk manager’s role as ‘professional apologist’.   He explained that every day he was communicating with unhappy patients trying to help bridge the gap between the unrealistic expectations set by the market and the reality of medicine.   His point was that medicine, by its very nature, is uncertain and yet the market, led by healthcare itself, has created an unrealistic expectation of perfection.

Nothing represents this more than the medical bill itself.    Most providers will tell you that they can manage their way through almost any post-surgery complication event until the bills hit.   Once the patient is getting those bills the mood all changes.    None of us like getting a bill and least of the large and unexpected type!

Most of the focus on healthcare reform has been on the economics associated with how services are paid for.  We need to spend more time on the system itself.    BLIS has developed an entirely new model that keeps the patient (and their payor) out of the billing process when a complication event occurs.   It’s a model that seems to be working very well.    Labor figured this out 100 years ago by developing a Workers Compensation system that provided a means by which employee’s would be protected from the medical bill.     Many States have for years had in place, ‘no-fault’ systems which pay for medical bills when someone is injured in a car accident.

I applaud the study authors’ effort and wholeheartedly support all efforts to reduce the incidence of a post-surgical complication event.     Unfortunately even the very best surgeons in the very best hospitals can and will have complication events.    Let’s make sure they don’t have to worry about the bills.   After all they have enough to deal with already.    As for the hospitals they will figure out how to make their necessary margins on the primary procedure.

The True Cost of Obesity

Recently, the respected Robert Wood Johnson Foundation (RWJF) released the statistic that by 2030, adult obesity rates could be as high as 60 percent in 13 U.S. states. Among the many follow-up news stories were those relating the cost associated with obesity. We have probably all seen the now famous Centers for Disease Control and Prevention color-coded obesity maps documenting the rise of obesity over the past couple of decades.

Along with these alarming statistics are the inevitable ‘costs’ associated with the increase in obesity. The RWJF report describes medical costs which could, “increase by up to $66 billion per year by 2030.” A staggering number to be sure, but how reliable is that number and what is behind those estimates?

I’ve tried to do my homework on this question. As a former corporate risk manager it’s always about the data. Unfortunately the data behind most of these projections is what I think of as questionable to say the least. I think the projections are way too low. Why? Consider the question of medical care.

From my review of the information, these medical cost projections are based on retrospective review of health claims. Unfortunately, health claims are not the only source of medical costs. Consider the self-insured employer market which may represent as many as 80 million covered lives. Any self insured employer is going to be financially responsible for not only the employer health benefit but also workers’ compensation medical care. According to one report, over $333 million were paid by employers for workers’ compensation medical in 2009.

Beyond the cost of medical care employers incur, there are the other ‘indemnity’ type loss costs such as paid time off, work comp indemnity, short and long-term disability and other associated employer provided benefit costs. My point is that in order to truly understand the cost of obesity we need to really dig into all aspects. I’ll continue to search for that information and comment here.