March 8, 2013
Are We Willing to Trust Patients? Models of Responsibility, Consumerism and Blame
Indiana Health Law Review Symposium March 8, 2013 Are We Willing to Trust Patients? Models of Responsibility, Consumerism and Blame Keynote Speaker: George Loewenstein, Herbert A. Simon Professor of Economics and Psychology, Dept. of Social and Decision Sciences, Carnegie Mellon University Location: Wynne Courtroom and Atrium, Inlow Hall, 530 W. New York Street, Indianapolis, IN 8:45 am-9:00 am Welcome Nicolas Terry, Hall Render Professor of Law & Co-Director, Hall Center for Law and Health, Indiana University Robert H. McKinney School of Law 9:00 am-10:00 am Keynote “Are We Willing to Trust Patients? Models of Responsibility, Consumerism and Blame”, George Loewenstein, Herbert A. Simon Professor of Economics and Psychology, Department of Social and Decision Sciences, Carnegie Mellon University Introduction David Orentlicher, Samuel R. Rosen Professor of Law & Co-Director, Hall Center for Law and Health, Indiana University Robert H. McKinney School of Law 10:15 am-11:30 am Responsibility for Health Care Costs Chair, Robert A. Katz, Professor of Law, Indiana University Robert H. McKinney School of Law Gregg Bloche, Professor of Law, Georgetown Law & Co-Director, Georgetown-Johns Hopkins Joint Program in Law and Public Health Christopher Robertson, Associate Professor of Law, University of Arizona James E. Rogers College of Law 12:15 pm-1:30 pm Consumerism, Self-Diagnosis and Self-Treatment Chair, Emily Morris, Associate Professor of Law, Indiana University Robert H. McKinney School of Law Jessica Berg, Professor of Law and Biomedical Ethics; Associate Director of the Law-Medicine Center, Case Western Reserve University School of Law Tracy Gunter, Associate Professor of Clinical Psychiatry, Indiana University School of Medicine; Adjunct Professor of Law, Indiana University Robert H. McKinney School of Law 1:45 pm-3:00 pm Personal Responsibility for Wellness Chair, Diana Winters, Associate Professor of Law, Indiana University Robert H. McKinney School of Law Leonard M. Fleck, Professor, Michigan State University, Center for Ethics Lindsay F. Wiley, Assistant Professor of Law, American University Washington College of Law
March 7, 2013
Position Announcement: Chair of the Department of Medical Humanities, Southern Illinois University (SIU)
The SIU Department of Medical Humanities offers a curriculum designed to provide medical students with core knowledge in the humanities, emphasizing application of the content and methodologies of humanities disciplines to the practice of medicine. These humanities disciplines include: ethics, health policy, medical history, medical jurisprudence, psychosocial care, and religious studies. Located in the capital of Illinois, this multi-disciplinary Department is part of an established medical school with a dynamic and collaborative learning and research environment that is internationally known for its medical education innovations and dedication to problem-based learning. Department faculty, through their teaching, research and service, draw upon expertise in such areas as health policy, law and medicine, ethics, psychosocial care, religious studies, and medical history and literature to foster dialog on health, health care, and the human condition. In addition to contributing to the education of medical students, residents and physicians, the Department is a key contributor to the school’s new M.D.-M.P.H. concurrent degree program and serves as the medical school home for one of the oldest and most robust M.D./J.D. dual-degree programs in the country.
Highlights of the positionand the area include:
- 12-month faculty appointment (established as a tenure-tracking position; however, candidates seeking a non-tenure faculty position will also be considered).
- A highly competitive salary and excellent benefits package.
- Great work/life balance in a “Top Places to Live” community.
- Family-oriented communities, excellent schools, and affordable housing.
- Easy access to metropolitan amenities in Chicago and St. Louis.
Qualifications: M.D.,Ph.D., J.D., or an equivalent terminal degree is required. The successful candidate must have experience that demonstrates readiness for leadership in the medical school setting. Ideally candidates will have demonstrated experience teaching medical students, health professions students, or small group teaching in other higher education settings and whose research focuses on health inequities and social determinants of health in rural and underserved U.S. communities.
For full consideration: All interested persons should apply to this position and submit a letter of interest, current curriculum vitae or resume’, and current list of professional references online at www.siumed.edu/jobs.
Review of applications willcontinue until the position is filled. Southern Illinois University is an Affirmative Action, Equal Opportunity Employer.
Position Opening: Duquesne University School of Law
Duquesne University School of Law invites application for a faculty position for the 2013-2014 academic year, which will be, depending upon the candidate, an entry-level tenure-track, a visitor, or look-see visitor position. We anticipate making an appointment that focuses on teaching and scholarship in the areas of Health Care (e.g., Health Law, Health Care Organization & Finance, Health Care Fraud & Abuse), primarily, and Professional Responsibility with other aspects of the teaching package subject to negotiation. (For instance, a course on Remedies may be an area of need.) Applicants should have superior academic credentials, previous teaching experience, and a record, or the promise, of excellence in teaching and legal scholarship, preferably in the area for which the appointment is sought. Entry-level applicants may demonstrate scholarly promise by publications in scholarly journals or scholarly works in progress. In the case of any applicant with tenure, a distinguished record of teaching and scholarship is required. We especially encourage applications from racial minorities, women, and others who would enrich the diversity of our academic community. Interested applicants should send a résumé and list of references, along with a letter of interest, to Professor Martha Jordan, Chair, Faculty Recruitment Committee at firstname.lastname@example.org. Electronic submissions only, please. Candidates are strongly discouraged from submitting an application by mail or from mailing other materials to the Faculty Recruitment Committee, although a list of published works may be appended to an application. The application period will close no later than March 30, 2013.
March 6, 2013
Retirees and Healthcare Costs
In a first rate article published recently on ssrn, Alison Hoffman and Howell Jackson present detailed empirical findings about the expectations people have about likely spending on healthcare in retirement. The issue is critically important, as Medicare pays for only about 60% of beneficiaries' healthcare coses, and this percentage is continuing to decline. Hoffman and Jackson had expected to discover that Americans as a general rule underestimated likely health care costs. Instead what they found was far more nuanced.
Women, for example, are much more likely than men to underestimate likely average expenditures in comparison to experts' assessments--yet women are likely to face expenditures that are significantly higher than those of men. Younger people are more likely to underestimate expenditures--despite rising healthcare costs that may portend higher expenditures for them than for current retirees. Moreover, people in general are quite likely to underestimate the degree of uncertainty there is about estimates of future expenditures and to distinguish among sources of uncertainty such as individual needs, changes in overall healthcare costs, or changes in Medicare and Medicaid policy. Another concern raised by the data is that some people may be significantly overestimating expenditures as a lump sum (in comparison to monthly outlays) and as a result becoming discouraged about their likely ability to achieve sufficient savings.
Based on these findings, Hoffman and Jackson suggest increasing efforts to foster financial literacy, particularly for women. They also suggest regulatory interventions to increase premium transparency and the availablity of low-risk insurance options as a way to buffer uncertainty. The article is a very nice example of how empirical research can question received assumptions--such as tha underestimations are uniform--in ways that might helpfully inform public policy.
March 5, 2013
Rewarding Healthy Lifestyles May Not Save Health Care Costs
In one of the first rigorous looks at the effects of employee wellness programs, researchers at the University of Arizona at Tucson and elsewhere concluded that the major effect of the programs on health care costs was to shift them from the inpatient setting to the outpatient settings. Costs for hospitalizations dropped, but costs for drugs and outpatient visits increased. The wellness program studied, at BJC Healthcare, a large St. Louis hospital system, targeted life-style influenced conditions: high blood pressure, diabetes, heart disease, chronic lung problems, serious respiratory infections, and stroke.
The ACA contains provisions designed to encourage the growth of employee wellness programs, including discounting up to 30% of the cost of employee coverage, and financial rewards for participating in healthy behaviors. If the thought was that participation in employee wellness programs would help lower direct health care costs, this study at least raises a serious question as to whether that is the case.
The study notes that it is possible that employers reap other benefits from wellness programs, such as reduced absenteeism and higher productivity. There is also the possibility that employees who participate in an employer-sponsored wellness program feel increased loyalty to their employer, and that is undoubtedly worth something. But it appears that we may have to look elsewhere to reap real savings in the direct costs of health care.
Cross-posted on Healthy Interests
March 3, 2013
Medicaid, Managed Care, and ACOs
Last week, Florida Governor Rick Scott announced that Florida had been granted a waiver to allow greater flexibility in its Medicaid program. Florida sought waivers for its medical assistance program demonstration project and for its long-term care program. Low income families, children in foster care, and Medicare/Medicaid dual eligibles, anong other groups, will be required to enroll in selected managed care plans. After receiving the waivers, Governor Scott supported Florida's participation in the Medicaid expansion of ACA, at least for a three year period. The support came as a surprise to some, and it remains unclear whether Republicans in the Florida legislature will regard the expansion favorably.
Florida's section 1915 long term care waiver has been fully approved by CMS and the waiver to allow a managed care demonstration project in Florida's medical assistance program has been approved in principle. The Florida legislation requiring the state to pursue managed care contains elaborate provisions to support access and care quality. These issues were specifically addressed in the letter from CMS expressing agreement in principle to Florida's waiver for its managed care demonstration project. Florida's demonstration project must also include selection of at least one provider group in every area where a group meeting standards applies.
Not surprisingly given rising Medicaid costs, Florida is not the only state pursuing managed care for Medicaid. In 2011, Utah also passed a Medicaid managed care statute (SB 180), but one with far less detail about quality measures than Florida's. Utah's waiver request was specific that the state sought to understand accountable care organizations in general terms as organizations that were willing to accept capitated payments and could meet quality standards. This understanding of accountable care organizations is very different from the federal sense of "groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program." The federal ACO goals are coordination by providers to improve care quality and thereby reduce costs through better patient management; ACO receive financial incentives, but only if they achieve quality goals along with cost savings. Unlike Florida, Utah does not include the requirement to offer provider groups among the managed care options for patients. The concerns of critics are that together with the capitation reimbursement structure, Utah's quality measures such as CAHPS and HEDIS are insufficient to prevent reversion to managed care of the more purely cost-saving variety. Utah has not yet decided whether to accept the ACA Medicaid expansion.