The 700th Anniversary Blog Question Is….Will a Government Shutdown Stop ObamaCare?


Caution Sign - Health Insurance Changes AheadLet’s start our Health Wonk Review this week by congratulating Brad Wright on publishing his 700th blog. With that, here’s  a link to Brad’s blog at Wright on Health where he discusses the issue on everyone’s mind this week: What will happen on October 1 when ObamaCare hits the marketplace? Brad tells us in Can the ‘Government Shutdown’ Shut Down ObamaCare? that even if Congress shuts down the government, it won’t affect the roll-out of the Health Insurance Exchanges very much. Read his blog to find out what inquiring minds want to know. Thanks for the info, Brad.

What happens under ObamaCare is going to look different from state-to-state. Some states are playing along nicely, while others are stubbornly planting their feet and putting their hands on their hips in a stance that looks like, “Try and make me!”

Playing Nicely with DC

California is one of the states playing nicely with DC.  To keep costs down for members, some insurers are building narrow networks of providers where they can control costs by writing aggressive contracts that keep reimbursement down in exchange for promises to drive volume to those networks. At Insureblog, Mike Feehan describes how this is likely to play out in Covered California in his entry this week called, cutely, Exchange THIS. Nice, Mike. And thank you to Henry Stern for submitting Insureblog to us this week.

obamacare-reformIn this next post, How the Left and Right View the Race to the Bottom, John Goodman’s Health Policy Blog should be required reading for anyone who wants to understand how insurance rates and benefit packages affect the cost/quality/access conundrum in healthcare. He explains how regulation that tinkers with any of those inputs will affect the others and also takes us to school on the importance of accurate rate setting for insurance. John tells us how this reality plays out in ObamaCare benefit packages everywhere.

No matter what state you are in, either physically or metaphorically, you will be impacted by some of the details of ObamaCare. Louise Norris discusses the loss of Health Reimbursement Arrangements (HRAs) under the new health insurance law at Colorado Health Insurance Insider in her post, No More HRA Funded Individual Health Insurance Policies in 2014…But Does It Make Sense? Her question seems to beg the answer.

ObamaCare is the result of the Affordable Care Act, which begets ACOs, which beget value-based payment models to replace good old-fashioned fee-for-service. In his blog this week, Vince Kuraitis discusses how the changing reimbursement structure will – over much time – result in healthcare transformation. Vince tells us, “Stop wondering whether healthcare transformation is occurring. It is. And it’s going to last. Recognize that now we are in a chaotic, amorphous middle state — the Neutral Zone — which is likely to last 3-10+ years.  Non fee-for-service revenue is emerging as a consensus indicator of healthcare transformation.”  Read the details and a great explanation of healthcare transformation in Vince’s e-CareManagement blog, Healthcare Transformation: Coping with the Neutral Zone for some interesting insights about how we are progressing through this transition.

For those true wonks, we love nothing more than a good graph. Nothing more, that is, than a series of good graphs. For that, I direct you to Bradley Flansbaum’s post, The Rate of MI Hospital Stays Decrease, Yet Total Cost of Care Goes Up? Over at his blog, The Hospital Leader, Brad tells the story beautifully (for those enamored with the beauty of data, of course) in a series of graphs showing trends on inpatient  and post-acute care. To quote Bradley, “Hint. It’s not what we do in the hospital, but after.” Good stuff here. It’s something we’ve suspected, and don’t you just love when the data bears it out?

And for the wonkiest among us, we have more on health economics from Jason Shafrin at Healthcare Economist. This week, Jason discusses an article from the New England Journal of Medicine that reveals the public and healthcare experts perceive very different reasons for Medicare’s always-impending insolvency. John and Jane Q. Public believe the core of Medicare’s financial woes can be traced to government mismanagement and hospital overcharges, while healthcare experts conclude that Medicare is over-treating patients. For more detail on this fascinating perceptual divide, read Medicare: Expert vs. Public Opinion.

East Capitol Street LevelWhile we’re on the topic of the federal government, let’s look at Liz Borkowski’s entry On Medicaid’s role in pregnancy care. Liz writes in her post, Expanding Medicaid Can Improve Birth Outcomes, at The Pump Handle that “Nearly half of 2010 US births were covered by Medicaid, and nearly half of US pregnancies are unplanned. Women’s health prior to conception influences the health of their babies, but it’s been hard for non-pregnant low-income women to qualify for Medicaid in most states. The Medicaid expansion will help more low-income women access healthcare before they become pregnant and can improve the health of their babies in coming years.”

More Acronyms than HHS in the Capitol

While for many of us, HHS is the center of the federal health universe, Julie Ferguson reminds us otherwise. Over at the USDA, poultry processing safety issues affecting both workers and the consumers who eat the products are the focus of legislation. Julie Ferguson from Workers Comp Insider tells us more at USDA: What’s up with your “for the birds” food processing legislation?

DC in the taillights

As we journey through the week’s blogs, let’s leave DC now – just like the national coordinator for health IT, Dr. Farzad Mostashari. I went to hear a lecture last week on the future state of health IT by Dr. Mostashari at the Leonard Davis Institute for Health Economics at the University of Pennsylvania as he prepares to leave his post, and added my blog to the swell of recognition for his service to HHS. For more on his lecture, visit our post, Dr. Farzad Msotashari’s Regrettable Departure as the Nation’s Health IT Chief, at Healthcare Talent Transformation.

While we’re in the health IT neighborhood, let’s visit a blog on how our national uptake and implementation chugs along all the while meeting some bumps in the road. Neil Versel at Meaningful HIT News says, “I catch two vendors acting in very bad taste. One apologized. I’m still waiting to hear from the other.” Read more at DrChrono and Sermo, what are you thinking?

Road Trip

interstate-95-to-new-york-city-sign-illustrationLeaving DC, let’s head up 95 to New York with Roy Poses at Health Care Renewal who offers an interesting post on some shenanigans involving a few New York City hospitals with common management. You may remember the well-publicized story last year about a reclusive hospital guest who overstayed her welcome at an Upper East Side hospital by about 20 years – but was glad to do so. The heiress showed her appreciation by leaving a sizable bequest to the hospital at the encouragement of the hospital management. If you want to know how that worked, and where it leads, take a look at Roy’s post, The Adventures of the Purloined Bequest, the Resident Heiress, and the Hidden Hospital System.

Farther North in Connecticut, two of our bloggers attended a seminar hosted by the Connecticut chapter of the Alzheimer’s Association. The issue was early detection, one near to my heart as I worked on checklists and a clinical protocol document for primary care physicians. Charles Smith and David Wilson of the Innovative Health Media Blog encourage screening in their post, Cognitive Screening Increases Well-being for Seniors. David tells us, “The Alzheimer’s Association is encouraging physicians to utilize Medicare’s Annual Wellness Visit as a way to identify early signs of Alzheimer’s and dementia.  Early prevention gives patients a better chance of benefiting from treatment, more time to plan for the future and care and support services not easily acquired when cognitive disparities are found late.”  Please visit his post to learn more about this very important issue, as Alzheimer’s is one of our costliest diseases, and one that is most devastating when it occurs.

As all healthcare trips should, we end ours with the patient.  After all, patients are the consumers in healthcare and in this Health Affairs blog, Thomas Lee, Chief Medical Officer at Press Ganey, discusses why measuring patient satisfaction will remain central to making healthcare better. Thomas writes, “The conventional wisdom among many of my closest physician colleagues is that the current surge in interest in measuring “patient experience” is a bit of a fad, and that the measures are not always central to the real work of improving patient care.  My take is that the opposite is true.  Measurement of what matters to patients is here to stay, and I think it is making health care better and will ultimately drive a renewed sense of professionalism for clinicians.” Read more about what Thomas has to say in his post, Patient Experience Will Drive a Renewal of Professionalism.

Finally, for a bit more on patient experience, David Williams of Health Business Blog looks at the current state of provider reviews and recommends we carefully consider the source when accessing online patient comments regarding their physicians. In Patient reviews: Don’t throw the baby out with the bathwater, David tells us that not all review sites are equal.

After our meandering, I am dropping you back off on your home turf to wait with anticipation the arrival of October 1, when the ObamaCare plans hit the exchanges. See you on the other side of the implementation.

Peggy Salvatore About Peggy Salvatore

Peggy has been developing managed care and healthcare reimbursement web-based training programs for the healthcare industry for 10 years. Recently, Peggy has written an eLearning program to help healthcare professionals understand the “meaningful use” of the new electronic patient record system. She also writes eLearning programs on general business topics such as time management, project management and leadership. Prior to that, her background includes extensive research, analysis and writing for professional journal articles, white papers and executive background briefings on a broad range of health policy issues. Learn more about Peggy at her website:


  1. Great job, Peggy (so MUCH great info!) – Thank you forhosting, and especially for giving Mike’s post top billing :-)

  2. Well done, Peggy! Your post is illuminating and engaging at the same time.

    As a patient care and physician advocate, I will say that Thomas Lee’s comments are clearly well-intended and serve as a useful reminder to all healthcare professionals that patient care is –in the end– the single most important ingredient in the increasingly convoluted healthcare mix.

    It should be pointed out, however, that the productive application of sophisticated “measuring patient experience” tools and processes is limited almost exclusively to hospitals and major healthcare organizations. Individual and small group physician practices know all too well how they are doing in the “patient experience” arena on a day-to-day basis. If they don’t know it, they can “feel” it.

    Taking a corporate-style “analysis paralysis” approach to measurement is entirely unrealistic in most small practices. I will often recommend a short, informal “How Goes It?” patient evaluation form be integrated in the payment or billing process and include an optional anonymous response, postage-paid return mail arrangement following each visit.

    An efficient small medical office has no time for computerized entry of this feedback. Form comment reviews can be quickly and easily isolated and reviewed in weekly status discussions. Doctors and staffs need reminders, not more computer stuff to analyze.

    Fancy measurements and overkill analysis of databases might satisfy the management of many large healthcare institutions, but –for small practices– they do not fairly identify or realistically present patient care problems. Nor do they solve them. Only practicing good medicine, combined with empathy, understanding, effective listening, communication, and stress management skills, can do that.

  3. Thanks Peggy, Your investigative reporter instincts are definitely shining in this issue of HWR. I look forward to hearing more about Dr. Farzad Msotashari’s departure and where the ONC will go now that they have lost their two top leaders. Something tells me you have much to say on the subject!


  1. [...] Salvatore hosts the Health Wonk Review blog carnival at Healthcare Talent Transformation. With all that’s going on in health care these days [...]

  2. [...] new Health Wonk Review is up with a collections of health policy blog [...]

  3. [...] blog post. That’s a lot of writing folks! To help us celebrate, read the Health Wonk Review here, and tell others about Wright on Health through email, Facebook, and Twitter. We have 701 posts [...]

  4. [...] …and asks the question “Will a Government Shutdown Stop ObamaCare?”  For more details, head on over to Healthcare Talent Transformation. [...]

  5. [...] “Will a government shutdown stop ObamaCare?” and many other timely topics are reviewed in the latest edition of the Health Wonk review.  You can read it here. [...]

  6. [...] Salvatore of Healthcare Talent Transformation did an excellent job with the Health Wonk Review this week, taking us on a legislative and healthcare policy roadtrip with lots of interesting stops [...]

  7. [...] The 700th Anniversary Blog Question Is….Will a Government Shutdown Stop ObamaCare? (Health Wonk Review) [...]

  8. [...] belated tip of the hat to the Health Wonk Review posted by Peggy Salvatore last week at Healthcare Talent Transformation. Peggy presents a nice collection of posts, including Tom [...]

  9. [...] belated tip of the hat to the Health Wonk Review posted by Peggy Salvatore last week at Healthcare Talent Transformation. Peggy presents a nice collection of posts, including Tom [...]

Speak Your Mind