Thursday's Thoughts

Anyone who is curious about rising health insurance costs need only look at two recent news articles.

The first concerns a recurring FEHBlog topic -- cost shifting from Medicare to commercial plans. A Washington Post article about Maryland's hospital rate regulators are considering a proposal by the Maryland hospital association to jack up their revenue substantially by charging commercial payers even more and Medicare and Medicaid even less under the rationale of "rebalancing."  Maryland is the only state that continues to regulate hospital charges. CMS requires Maryland hospitals to pay the Maryland regulated rates rather than the standardized DRG charges for Medicare patients. “It brings Medicare costs down, so it gives something” to federal officials seeking price relief, said Barry Rosen, a Baltimore lawyer who works for insurers. “It sure raises the price of care to people in Maryland.”

The other article from the AP concerns a study published in the AMA Journal suggesting the bariatric or weight control surgery can reduce the number of diabetes type 2 cases.

Doctors are reporting a new benefit from weight-loss surgery — preventing diabetes. Far fewer obese people developed that disease if they had stomach-shrinking operations rather than usual care to try to slim down, a large study in Sweden found.
The results, published in Thursday’s New England Journal of Medicine, are provoking fresh debate about when adjustable bands and other bariatric procedures should be offered.

It is ‘‘provocative and exciting’’ that surgery can prevent diabetes, but it is ‘‘impractical and unjustified’’ to think of doing it on millions of obese adults, Dr. Danny Jacobs, a Duke University surgeon, wrote in a commentary in the medical journal.

Dr. Mitchell Roslin, bariatric surgery chief at Lenox Hill Hospital in New York, disagreed.
‘‘If surgery is the only treatment we have, we have to accept the cost ramifications of that’’ and give up ‘‘the naive notion’’ that we can just teach severely obese people how to lose weight, said Roslin, who consults for some makers of bariatric surgery equipment.

Unquestionably obesity is linked with diabetes type 2, but is this really cost effective? Moreover, you can bet that lawyers are lining up to represent the lap band surgery patients because there are bound to be unanticipated consequences of this surgery. The Wall Street Journal had an article this week about the consequences of heart surgery on young patient cropping up when these people reach adulthood.  This is not to suggest that there is no place for bariatric surgery or heart surgery because there can be adverse consequences. The FEHBlog agrees with Dr. Jacobs, but the pressure to push to cost curve up is always there.