I’ve had a physician tell me, in strictest confidence, that the hospital replaces physicians who leave with any available MD, regardless of their expertise. “They see an MD as an MD, and that’s it.” We have to wonder what effect this has on patient care.

In an ideal practice setting, medicine and surgery are used in a two-way connection between a doctor and a patient, with support from leadership, staff, and the care team. The clinician has all the tools they need to heal. The goal should be to do what is best for the patient at all times.

But there is ample proof that the health system is becoming increasingly corporate. In 2023, 65 hospitals or health systems revealed deals to merge or buy other hospitals, bringing in more than $38 billion. The business of medicine is a big part of the economy, especially since the US spends almost $5 trillion a year on healthcare. And the system is underperforming.

Private equity investors have a big stake in the US healthcare system; they own more than 30% of hospitals in some markets and almost 400 hospitals. Little is left for the smaller hospitals or, indeed, the single practitioner who wishes to work independently. Little by little, they are being forced into a market that seems to smack of monopolistic practices.

In America’s profit-driven healthcare system, physicians believe they are hurt when managers, hospital executives, and insurers make them break the rules of ethics that were supposed to guide their profession. It is hard for many physicians to balance their Hippocratic oath with the reality of making money off of sick and vulnerable people. Some say this promotes a very high rate of physician suicide and burnout.

The 2024 physician burnout and depression study from Medscape says that almost half of physicians feel burned out. The number of physicians who are burned out has gone down since last year, when 53% said they were burned out. But many are considering leaving the field. Due to employees quitting, the resource gap in available care will widen. Nurses, too, are leaving the field because of overload, lack of support, and wages.

A physician I spoke to told me that he resisted being bought by a hospital chain and, as a result, will not be permitted to admit patients there or receive referrals; they are squeezing him out of existence. He now plans to leave medicine in about two years. The daily stress of dealing with insurance companies is exhausting for his staff.

The concerns regarding patient care are real, and the US government realizes them. The Office of Civil Rights in the U.S. Department of Health and Human Services released a rule about the nondiscrimination section in Section 1557 of the Affordable Care Act (PDF). This rule could punish doctors if they use algorithm-based tools that cause discriminatory harm.

The Federation of State Medical Boards also put out a set of rules saying that doctors are responsible for harm caused by tools that use algorithms. But what if the physicians or staff have little say over how algorithms are used and who uses them? Can we hold them responsible for management’s actions? And, if management is a private equity company, where does the buck stop? Harry Truman knew.

A new report from the World Health Organization (WHO) discusses five fundamental ways AI LLMs could be used in medicine and public health: diagnosis, patient care, administrative chores, medical education, and research. However, the study also warns that AI comes with big risks of bias, unfairness, privacy breaches, and problems with openness.

Experts and civil society groups share these worries. Depending on algorithms that are devoid of emotion and only deal with data is taking a road too far and giving too much power to a math formula over medical staff and patient input. In fact, there is NO patient input, only data.

One patient I knew who found a major error in the EHR attempted to have it remediated to the correct information—it took seven years, and the patient was told the hospital could do nothing about the EPIC software errors. How is it possible that a program has no fail-safe corrections for inaccurate diagnoses, treatments, or medications and on which major health decisions are made?

One thing about making professional decisions is that the situation is often much tougher and more complicated than people think. The assumption is that it is not hard to make a medically complicated decision. You need to gather a few facts and think about them like a medical professional (i.e., a doctor), and you can figure out exactly what the patient is sick with and how to treat it. That’s how AI would act, and it would be done within minutes if not seconds.

But medical staff need to consider more variables than the AI may have been trained on and therein may lie a bed of thorns. Who is truly conversant with the limits of AI training and the bias inherent within its vast network? Certainly, hospital staff aren’t equipped to do much. What are the potential harmful effects?

The AI tools and machine learning (ML) methods that make them up are not perfect, and it is not likely that they will ever be. So, adding AI will bring benefits and the common problem of AI tools making mistakes. According to a study from the European Parliamentary Research Service, one of the biggest risks of putting AI into healthcare is that it could hurt patients through mistakes.

Are hospital administrators or private equity managers up to the task of monitoring instead of zeroing in on the bottom-line savings of AI? Instead of becoming a major moneymaker for them, it could become a swamp of lawsuits that will push some of them into bankruptcy from major decisions against them.

Caution seems to have been thrown to the wind in the heady giddiness that may be exhibited by people who should know better. Yes, I realize I am being caustic, but people’s lives, livelihoods, and professions are on the line. We are not talking about trading stocks but working with lives.

The post Hospital Managers, Medical Decisions, and Patients’ Need to Know appeared first on Medika Life.

With figures quoted in past weeks for those recently hospitalized for Covid-19 infections, one clear trend is emerging. It’s the unvaccinated that are taking up beds and developing severe and often terminal cases of Covid-19. Take this staggering statistic.

“99.2% of U.S. COVID deaths in June were unvaccinated people”

In countries where there are vaccine shortages, the problem is even more pronounced. South Africa has vaccinated around 3 million of its 60 million people and a third wave is now sweeping the country, with hospitals at capacity. There simply are not enough vaccines available.

America doesn’t have this problem. They suffer from an even greater conundrum, one that has had the Federal government scratching their heads. How to overcome vaccine hesitancy in a country beleaguered by conspiracy theories and radical fringe elements bent on discrediting the scientific community.

Arguably a community that during the course of the pandemic, has often proven at times to be its own worst enemy.

Currently, large swathes of America — notably in Republican territories — remain unvaccinated and their intent is clear. To remain so. As the Delta variant gains a new foothold in states like Texas, Florida, and Mississippi, and hospital numbers again begin creeping upwards, health care insurers are on the verge of providing the impetus for covid vaccination the federal government has to date been unable to supply.

And sadly, for the unvaccinated, it’s not just their healthcare insurance but life cover too that will be affected.

Vaccinate or pay up

Various scenarios are going to emerge over the coming weeks. I’ll deal with the most likely and least controversial first and for those considering this an immoral use of pressure to ensure vaccination, please consider this. If you were a house and you were unvaccinated this what you currently look like to insurers.

If you build a house in an area prone to flooding, your home insurance is going to be adjusted for the risk. Choose higher ground, where it’s safer and the premium drops to reflect the lesser risk. Health and life insurance are no different. If you smoke or drink heavily, your premiums reflect it. More risk.

1. Increased premiums from private insurers

If you are not able to provide proof of vaccination to your healthcare insurer, expect your monthly or annual premium to skyrocket. There is clear statistical data now available for healthcare insurers to develop risk models for the two scenarios. Covid-19 vaccinated versus the unvaccinated.

Understand you’re not being forced to take the vaccine, you’re merely being penalized for not taking it. Like building that house on flood-prone land. If you’ve been vaccinated you pose far less risk and therefore will benefit directly by not facing increased premiums. Hell, they may even give you a discount.

This is a sound business move and in an industry that can ill afford to increase the risk they carry, passing it back to you in terms of increased premiums will be the most immediate response. Look at it along the lines of gentle persuasion. Help us and we’ll help you.

2. Refusal of coverage, or exclusions

The alternative option is one of refusal of coverage, and one that may well be favored by some companies, and may possibly even affect Medicaid should a desperate government be able to address changes to the Affordable Care Act. In other words, if you are not vaccinated against Covid-19, you will not be eligible for medical coverage for Covid-19.

Various models can be explored under this scenario. Increased payment from the insured (larger excess payments for the unvaccinated) is one possible solution all though many insurers may simply choose to void coverage entirely.

Life insurance premiums

Exactly the same logic applies to your life coverage. Like it or not, pro-vaccine or anti-vaccine, your personal life cover is based on risk. Without the vaccination, your risk of death is increased. If you already suffer from related conditions likely to aggravate a Covid-19 infection, obesity, diabetes, heart conditions, and other diseases considered comorbidities, expect a massive hike if you’re unvaccinated.

Conversely, those vaccinated may well be in for a small premium reduction to reward them for playing ball, so to speak, in terms of managing their risk profile. Again, for the conspiracy crowd, this isn’t a coercion tactic. It’s about simple business and risk models. Stop smoking and drinking, shed fifty pounds, and watch what happens to your premiums.

In exactly the same way your address affects your insurance premiums, so too, your Covid vaccination status.

The post Vaccinate or Pay up. Healthcare and Life Insurers are About to Solve Vaccine Hesitancy appeared first on Medika Life.

Despite political attention, majority of Americans don’t realize Affordable Care Act plans cover pre-existing conditions

Date of Release: Oct 21, 2020

NEW YORK /PRNewswire/ — Many Americans are confused about the basics of health insurance, despite widespread attention on health care during this year’s global pandemic and election season.

According to an annual survey from Policygenius, the nation’s leading online insurance marketplace, a majority of Americans (62.8%) do not realize Affordable Care Act plans cover those with pre-existing conditions, a defining characteristic of the law and a political flashpoint during the 2020 election season.

Nearly nine out of ten Americans (87%) could not identify the correct timing of open enrollment for Healthcare.gov, which runs from Nov. 1 to Dec. 15 this year, and almost 44% of Americans did not believe plans sold on Healthcare.gov covered required benefits like pediatric care.

Lack of health insurance literacy may also be leading people to avoid necessary medical care. The survey found that around one in four Americans (25.5%) have avoided care because they didn’t know what their health insurance plan covered. More than 8% have avoided COVID-19 testing, treatment and care because they were unsure whether it was covered.

“This year’s findings are largely consistent with last year’s, which tells us that health insurance literacy has not improved, despite widespread attention in the past year from the global pandemic and election season,” Hanna Horvath, health care expert at Policygenius, said. “The persistent confusion speaks to the complexity of the health care system in our country, as well as the effects of conflicting information during debates in the news and in court cases.”

The fourth annual Policygenius Health Insurance Literacy Survey also found:

• Only 32% of respondents were able to correctly define premiums, copays and deductibles, three of the most common health care expenses.
• Only 5% of Americans could correctly identify six basic tenets of American health care law, including that children can stay on their parent’s plan until age 26.
• Americans who make less are more likely to avoid care: 36% of people making less than $75,000 annually said they avoided care because of uncertainty over what their health insurance covered, compared to 24% of those making more than $75,000.

As a leader in financial protection, Policygenius is dedicated to providing free and educational health insurance content, like this state-by-state guide to the Affordable Care Act, to help consumers understand their options. As an independent insurance broker, Policygenius also enables consumers to shop for and secure the protection that best meets their needs.

Policygenius’ survey is based on responses from a nationally representative sample of 1,501 American adults. It was conducted through Google Surveys from Sept. 23 through Sept 28, 2020. You can read the full report here.

About Policygenius: Policygenius is the nation’s leading online insurance marketplace, with headquarters in New York City and Durham, North Carolina. We’ve helped more than 30 million people shop for all types of insurance like they shop for everything else — online — and have placed over $60 billion in coverage. Policygenius launched in 2014 and is one of the early insurtech pioneers. Policygenius launched wills and trusts through a new mobile app in 2020. Policygenius was named to Forbes’ list of Best Startup Employers (2020), Crain’s Fast 50 (2019) and Inc. Magazine’s Best Workplaces (2018, 2019, 2020).

For more information:
Brooke Niemeyer
Associate Director of Media Relations
brooke.niemeyer@policygenius.com 

SOURCE Policygenius

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