Monday, December 29, 2008

Should we return to the Certificate of Need (CON)?

In the 70s and 80s many states had health care Certificate of Need (CON) laws.

In generally, the CON required state approval for the construction or major renovations of hospitals, the construction or major renovation of nursing home beds, and the addition of major technology, such as imaging centers.

The laws varied by state so the generalization did not apply exactly to each state. I believe there may be four (4) states that have retained CON laws (one being Michigan).

When I was young and naïve I believed the CON was based on the formulas built into the law. After some experience I learned that in the states I worked the CON process was rotten with politics, money and influence peddling.

Many states repealed the CON rules because the process did not work, or as a deregulation maneuver.

The market did actually work in one instance, nursing home beds are not being built despite the absence of CON laws, largely because seniors housing and assisted living centers have created a continuum of care that minimizes the need for nursing home beds.

So should we allocate health care capital via the government? What happens to the political losers? Would this slow capital spending, and is that a good thing? How do we keep rotten politics out of the process?

Sunday, December 21, 2008

Nursing Home Rating System

The federal Department of Health and Human Services, Center for Medicare and Medicaid Services, has instituted a "five star" nursing home rating system.

The idea is to provide useful information to families and residents, consumer advocates and government officials.

Having spent 30+ years involved with nursing homes, and having been involved in all phases of the regulatory system, I am skeptical.

To be fair, CMMS includes the weaknesses in the rating system in the narrative explaining the system.

Nursing homes are the most highly regulated sector of the health care system, and are targets for consumer advocates, bureaucrats and on-the-make politicians.

Some snowy afternoon I am going to spend a few hours looking at some homes I am familiar with, and see if the rating system has any connection to reality.

Friday, December 5, 2008

Say it Ain't So!!!

From the Wall Street Journal, December 5, 2008

Daschle Launches Push for Health-Care Overhaul (excerpt)

"Mr. Daschle, who Obama transition officials say will be nominated secretary of Health and Human Services, will suggest that Americans hold holiday-season house parties to brainstorm over how best to overhaul the U.S. health-care system. He will promise to drop by one such party himself, and to take the ideas generated to President-elect Barack Obama."

Worst idea ever?

Thursday, December 4, 2008

Health Care and Stimulus

I am still working my way through the Baucus white paper, and promise a summary soon.

While you wait, Jonathon Gruber has some interesting ideas about health care and economic stimulus (hat tip to Mark Thoma, and copyright the New York Times).

I do not exactly follow some of Gruber's numbers, but it is worth a read, and he clearly understands the there are issues at the state level.

Also, Gruber implies laid off workers can fill the gaps in primary care by becoming nurse practitioners, RNs and physicians assistants. Ah, maybe with five or six years of education, not exactly a short term fix.