A Simple and Inexpensive Message

 

This inspirational quote says it all. No need for multi-million dollar studies by institutes, government agencies, nor non-profit agencies.

 

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Health Insurers are Feeling the Pressure of Looming PPACA

 

In a series of announcements it becomes apparent that things are not well in the health insurance industry.

Shareholders of WellPoint (Blue Shield in California) are griping about a reduction of their dividend by lowering its 2012 adjusted earnings forecast to a range $7.30 to $7.40 a share, down from $7.57 a share (yes, that’s correct….approximately 15 cents/share. Times must be even tougher for them than the uninsured, and unemployed.

Further investigation

Shares of the nation's second-largest health insurer fell 12% in midday trading, and the disappointing results dragged down shares in other insurance companies.

In contrast, rival UnitedHealth Group Inc. raised its full-year profit estimate when it reported second-quarter results last week.

WellPoint said second-quarter profit decreased by 8%, which also fell short of Wall Street expectations.

The company reported earnings of $643.6 million, or $1.94 a share, compared with $701.6 million, or $1.89 a share, in the same period a year ago. More shares were outstanding in last year's second quarter.

Enrollment during the quarter ending June 30 dropped 2% to 33.5 million members as WellPoint cited heightened competition in certain markets.

The company said it expects medical costs to rise by about  7.5% for 2012, a slight increase over its previous forecast. Overall, revenue in the quarter ended June 30 rose nearly 2% to $15.4 billion.

Angela Braly, WellPoint's chief executive, said, "We are disappointed with the need to lower our guidance but believe it is the right action to take given the challenging market we see."

Later in the day Angela Braly was sacked by the Board of Directors

Angela Braly, the chief executive of WellPoint Inc., resigned late Tuesday after intense pressure from shareholders who have been unhappy with the company’s performance.

WellPoint announced that John Cannon, its general counsel, would temporarily fill the CEO role until a replacement is chosen. Cannon is not seeking the role permanently.

WellPoint, one of nation's biggest insurance companies, is the parent of Woodland Hills-based Anthem Blue Cross.

“Now is the right time for a leadership change,” Jackie M. Ward, the company’s lead director, said in a statement. “We believe the remaining executive team is dynamic and strong, with great potential to drive WellPoint’s future success.”

Shareholders have been vocal in their dissatisfaction with the performance of the company under Braly. They have decried the company's lagging stock, managerial missteps and disappointing earnings.

Still, the timing of Braly’s resignation is a bit unusual in that WellPoint agreed last month to purchase Medicare provider Amerigroup Corp. for $4.9 billion. It is uncommon for companies undergoing a significant acquisition to change leadership so soon after the announcement of a deal.

The investor unrest follows years of consumer fury that beset WellPoint as it repeatedly raised premiums on many families and small businesses by 10% or more. The nation's second-largest health insurer runs Blue Cross plans in California and 13 other states and has more than 33 million customers nationwide.

A New York hedge fund, Royal Capital Management, sent a letter to WellPoint's board last week saying that Braly has "failed miserably" as CEO and that "it is incumbent upon the board of directors to fulfill its fiduciary responsibility to shareholders by changing leadership." Royal Capital, which held about 838,000 shares of WellPoint as of June 30, declined to comment further Monday.

It’s not encouraging to know that Wellpoint’s patients’ welfare is in the hands of hedge fund experts, who are not exactly known for their pristine ethics or morals.

Let’s hope that the  free market enterprise system can self correct to overcome the foolishness of Obamacare.

 

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Online Physician Ratings: Know What's Being Said About You By Simon Sikorski, MD | August 13, 2012

 

This?                                            or  This?

                     

Last week, 50 doctors in New York gathered for a meeting to discuss one of the biggest controversial topics affecting their association: Each doctors' online reputation. Most of the attending physicians have embraced patient reviews into daily activities while others have not. How serious has the issue of online reputation become?

Like it or not, physicians are being drawn into social media.  One of your group associates may be online in other settings which might influence your own reputation.

It behooves you to ‘Google” yourself and read what is on the internet, and if necessary do whatever is necessary to edit the content.   Not having a Google identity can also have a negative connotation as much as ‘negative review’.  Ignore social media and Google at your own risk.

In less than one year, patients’ online behavior of how they look for doctors has changed by 65 percent. Eighty percent of new patient volume will screen their doctors on Google. In 2011, physician ratings sites accounted for only two percent of that behavior. Now it’s 60 percent, according to comparison of our 12 case studies vs. 120 online marketing campaigns in 2011. In early 2012, most of the digital health companies have started big advertising campaigns competing to list physicians and offer statistics about their practices.

Doctors are becoming very concerned about how their colleagues’ online reputations impact the profitability of their organizations. In one case study for an ambulatory surgery center, we showed that improving the reputation for six of 15 doctors brought in 33 new out-of-network cases in less than four weeks. Why was this so significant? Because previously the same ASC had to spend about $8,000 in advertising just to get five out-of-network patients.

Physician Reputations and Review Websites: Who Owns Your Name?

There are no longer any doubts that patients Google their doctors. In the case of patients seeking fee-for-service options, the behavior of turning to “Dr. Google” occurs 100 percent of the time. What your patients find at that point is critical for your bottom line. The information below will help you understand why taking charge of physician online reputations has never been more important and why you should take action now.

The reason for taking action now is because there are now over 100 doctor review websites creating businesses structured around your name. Any doctor without a strong online presence by the end of 2011 is already affected. At this point, any doctor with a license already has a profile somewhere. This is especially true for group practices and hospital-employed doctors who almost never have any other public-facing profiles they own outside of what their employer publishes about them on the corporate website.

The impact of doctor review sites on a medical practice and hospitals. The implications for the hospital brand and their profitability were severe. In one example, a small ASC was outcompeting a local hospital purely on the fact that their doctors embraced patient reviews and the hospital was still afraid of even featuring the doctors on its own website.

Here are some of the most disturbing findings about what physician rating sites publish and why you should do something about it now:

1. Outdated reviews, some from four to five years ago

2. Outdated addresses and phone numbers. Why is that significant? When that phone number rings at your old practice, that’s where you’re losing your patients to. Again, for group practices and hospital-employed doctors, this is even more significant because some hospitals are monetizing on this while the actual place where they do work, is failing. Yes, that's right. When patients call a physician's old phone number the receptionist schedules those patients to see their doctors.

3. Old patient satisfaction scores marked as percentages. Most of the surveys were filled out years ago by one to four people. The two most important questions for you are: How many patients do you see during the year? Are between one and four reviews representative of that number?

4. Physician rating websites advertise on Google for your name. This is perhaps the most unethical practice. Here’s the hidden business structure:
• The company publishes advertisements for your name
• Public clicks on the advertisements to go to a website where either bad reviews are posted about you, or an empty profile exists
• Next to your name are doctors that purchased an advertisement on that website and are displayed front-and-center
• In effect, your name is directing your possible patients to other doctors
•Those listings offer patients ability to call for an appointment or schedule one via their platforms

So in addition to paying for a subscription, physicians advertising on these sites are paying for new patient leads. Furthermore, the company has to be “fair” to all subscribers so it will advertise for different doctors at different times so that patient volumes can be distributed more evenly or more patient leads can be given to subscribers who pay premium fees.

For doctors in New York state, the problem is even more significant. The New York Department of Health forbids doctors to publish patient testimonials, while these businesses can. When I spoke to our legal counsel, I found out that the regulation is so broad in its meaning that it prohibits the doctors to use patient reviews in any format. There is no such regulation for the ratings websites.

“Dr. Google” has become the most feared background check available to anyone with access to the Internet. Mobile phones made that access possible to virtually everyone. In effect, Google has become a reference check that establishes a level of trust for an appointment to be scheduled. What patients find is completely up to you. I hope this short expose proves of value for doctors still thinking whether they should invest in their online reputations.

 

Simon Sikorski, MD is the CEO of Healthcare Marketing Center of Excellence. He is a regular speaker at physician conferences about reputation management, brand advertising, and ROI from internet strategies and social media. E-mail him here.

 

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Breaking News on the Social Media Frontier

 

                            

The Second Generation of Social Media advances on health care. We are just at the frontier of social media engagement in healthcare.

I am one who sees things out of the box. I rebel at walls, at being defined by others and observe a wave of rapid advancement triggered by the infinite number of interactions between physicians and physicians and patients and patients and patients. (read that one slowly).  Rather than being bridled by old rules in a new medium, unless we adapt and change we will be swept away by new media just as newspapers and print book now play a much less dominant role in publishing.

It becomes apparent how mobile health is revolutionizing health care in countries that have a much greater shortage of physicians and larger population health challenges. In those countries there is no ‘box’ to restrict innovation and growth. It will be necessary for us to break down barriers and ‘rule’ set forth by government which decrease efficiency and increase costs.

Events in social media evolve at a quickening pace.  At a time when healthcare has accepted social media, social media evolves further.

Not so  subtle changes are being announced by the creative genius of what I would call “socialite media experts.  Simplicity of design, intimacy of intercourse, and        .

New domains, such a Medium, Branch, Beyond, Lift, all the progeny of Obvious (the original owners of Twitter).

Lift has a blog describing it’s goals .

Obvious describes itself in this manner, “The Obvious Corporation is more of a philosophy than a company or product. We focus our long term view on ideas and technology that can be generally described as “world positive.” When opportunities resonate with our worldview, we do what makes sense to help them succeed. So far, a small portfolio of companies across a variety of disciplines and a vision for how publishing could be improved have grabbed our attention.”

Medium presents a forum for stories, as  “collections” , which are defined by a theme and a template, as well as photographs.

Meanwhile  check out these:

Been There. Loved That 

Look What I Made

The Writer’s Room

 

All of these sites have popped up in the past several months. All are currently in beta and being rolled out by invitation .

As Steve Jobs said,

“Stay hungry, Stay Foolish”  (Stanford University 2005, commencement address)  His statement was not original since it originally appears on the back page of THE WHOLE EARTH CATALOG 1974

                                      

Is Social Media the current  iteration of “The Whole Earth Catalog?”  Is Social media a form of counter-culture revolution in the same manner as the catalog was at that time?

 

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Hippocratic Oath, Then and Now

 

In the midst of chaos and turmoil for physicians in America it is as important as ever to maintain our hippocratic oath.  Now is the time to review what we swore to (if your medical school even does this at graduation. )  This should excite you as much as your first ‘white coat’.

 

As you will read below it has been modified somewhat.

           OR          

Let this be your ‘straight ruler’ to compare to what we are all going through at the moment, and remember, it too shall pass, and change….but real meaningful ethics barely change. The FTC, FDA, SEC, CMS and government  will change and change as people do. Physicians, Ministers, Rabbis, ( I include Priests) (and MDs are ministers to your health)

Few medical schools today require students to recite the classical version of the oath. Enlarge Photo credit: public domain

Hippocratic Oath: Classical Version

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

—Translation from the Greek by Ludwig Edelstein. From The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.

Just as medical textbooks have come a long way from Hippocrates' archaic writings, the modern versions of the oath veer far from the classical. Enlarge Photo credit: Aldus Manutius/public domain

Hippocratic Oath: Modern Version

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

 

                             

 

Editor's note: To add your own comment as a doctor or a non-doctor,

 

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Mayo Clinic Report on Physician Burnout

 

A national survey of 7,288 physicians (26.7 percent participation rate) finds that 45.8 percent of physicians reported at least one symptom of burnout, according to a report published Online First by Archives of Internal Medicine, a JAMA Network publication.

The Mayo Clinic today released the finding of a study on physician burnout. Not surprisingly (if you are a physician) the stunning findings, perhaps to the public, is that over 30% of physicians in general have documented burnout (according to psychiatric standards), and the highest rates of over 50% were among emergency room,family doctors (primary care physicians) and the internal medicine specialty.

Symptoms and signs include depersonalization, lack of involvement with patients, insomnia, loss of appetite and other signs of clinical depression. It was also found that over 50% of physicians are considering leaving clinical practice, early retirement or part-time medical practices.

This is occuring at a time when patient load will increase by about 25% due to health reform, which includes increasing bureaucracy not directly connected with patient care.

Most physicians recognize their own burnout symptoms and categorize it as depression. It however has other signals which differentiate it from clinical depression. It mimics post traumatic stress disease, seen in the military. The duration of chronic stress exacerbates signs of burnout.

There are physiologic and biochemical changes which occur during burnout, much like clinical depression. It is well known that anxiety creates the release of circulating hormones such as norepinephrine and corticosteroids as well as changes in neuro-mediators in the brain, such serotonin and inhibitors.

The obvious outcome of this is markedly reduced physician efficiency, increased errors, and disability, either acute or chronic.

The figures reveal how health care is impacted by these numbers.

A lack of control about the future and working conditions in many professions reveals that these factors also lead to apathy and burnout.

In medicine this is apparent. Most physicians know that physicians have little to do with the operations of the business of medicine, health insurance reimbursement, regulations, medicare and medicaid regulations.and find a greater and greater percentage of work time involves non- clinical work.

When queried physicians in the majority enjoy charitable care, however cannot individually support it in the present setting of medicine in the United States. While medicare payment have a due process for adjudication of disputed or rejected claims, often times state medi-caid plans do not have a mechanism which is usable to dispute disagreements. These factors contribute much to the uninsured challenge.

 

For providers time is money just as it is for all employers/employees. There is a limit as to how long a medical business can pursue these claims. It is also possible to seek legal relief, however the cost of this is prohibitive for small groups. Some hospitals or larger groups can afford the legal fees to pursue this course, and occassionally successful. While a patient can be sent to collections, how does one send medicaid or medicare to collections. In fact the provider is effectively extorted to agree to the rules present in the credentialling process. It's one thing to say okay I am going to extend 'credit' or discounted rates by choice, but another to coerced or mandated discounts. In fact most insurers have a disclaimer that their rates can be altered at anytime. The provider is free to disenroll or accept the changes. The provider has an ongoing ethical and legal obligation to continue care or be sued for abandonment if continuing care is not arranged.

While patient care can be stressful, the training process usually deals with clinical issues that cause stress. It is all of the above collateral challenges that cause burnout. Long hours, lack of recognition and the blatant disregard for physicians by insurers. Rarely does an insurer send a note of appreciation to their panels for 'good care' for the companies insured.

The fact that almost 1 in 2 U.S. physicians has symptoms of burnout implies that the origins of this problem are rooted in the environment and care delivery system rather than in the personal characteristics of a few susceptible individuals," the authors conclude. "Policy makers and health care organizations must address the problem of physician burnout for the sake of physicians and their patients."

 

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Money Money, Who’s Got The Money?

 

Most of us know where the money is going, and it’s not to physicians or providers. There is much money to be made and had in our health system, whether it becomes socialized, nationalized or universally paid.  Universal payor? It’s your wallet. What’s left? Not much.

Insurance companies are doubling down  to hedge their bets.

Health insurance companies bitterly opposed the health care reform law but, as the merger between Aetna and Coventry Health Care announced Monday shows, the industry knows there's still money to be made.

The $5.6 billion Aetna-Coventry Health Care merger is the biggest in the health care sector since President Barack Obama enacted the reform law in March 2010. The deal will give Aetna, the third-largest health insurer in the U.S., a big increase in Medicare and Medicaid customers, including poor elderly people on both programs, and in the number of people who buy insurance on their own or get coverage from small businesses. Aetna will gain 5 million new customers when the merger is complete and stands to get even more in the near future.

"You've got an arms race going on in health care," said Robert Laszewski, a health care consultant and president of Health Policy and Strategy Associates in Alexandria, Va. Laszewski said health insurance companies, hospitals and other players are merging into bigger entities in hopes of restraining their own costs and grabbing larger shares of the markets as they are reshaped by health care reform. What the Aetna-Coventry Health Care merger won't do, at least in the short term, is lower anyone's health insurance premiums, he said.

The health insurance industry is undergoing a transformation as a result of the health care reform law, which the Supreme Court upheld in June. Twenty-five million people will buy health insurance on the law's regulated "exchange" marketplaces in the states, according to the Congressional Budget Office. Many of those small businesses and people who don't receive health benefits from their jobs will get federal tax credits. Medicaid will also add 11 million poor people and states are expected to contract with private health insurance companies to cover them.

Huffington Post expands on this post.  It’s worth reading….Health Insurance companies, like the American Medical Association and others did the ‘FLIP-FLOP’ at the last minute, they saw where your money is going….

                                      

 

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