A new kind of doctor’s office that doesn’t take insurance and charges a monthly fee is ‘popping up everywhere’ — and that could change how we think about healthcare – Business Insider

Interesting article after the previous post.

Direct primary care is a small but fast-growing movement of doctors who don’t accept insurance and instead charges a monthly membership fee.


In Rural Washington, Pediatricians A Scarce Commodity -KUOW

More on the slow motion collapse of our health care system. The problem, across the board is that medical professionals are getting squeezed by both State healthcare systems and large insurance companies. If you aren’t willing to raise your taxes to cover your physicians costs, you won’t have one. Here’s a case study right here in our state.

For the past 16 years, Jill Hutton has been managing a pediatric clinic in Aberdeen that once treated 70 to 100 children a day. But now it’s empty. She’s working on shutting it down



New Study Finds Hundreds of Thousands of Washington Patients Receive Unnecessary Tests, Procedures, and Treatments – WA Healthcare Alliance

– In one year, an estimated $282 million was spent on “wasteful” health care for 622,000 Washington patients

– Washington becomes just the third state in the nation to use a new tool called the MedInsight Health Waste Calculator to measure health care waste and put a price tag on overuse

To anyone familiar with the healthcare industry, this is no news. Doctors overuse tests and procedures because they are worried about lawsuits, and the insurance industry demands they do them. And just to point out, the use of “Big Data” again shows that we can learn much from studying the vast arrays of data being collected in our new world of electronic records, etc.

SEATTLE, Feb. 1, 2018 /PRNewswire-USNewswire/ — In a groundbreaking analysis of 1.3 million patients across the state who received a health care service known to be commonly overused, the Washington Health Alliance found that nearly half of the patients received care that is considered low value, or wasteful. That overuse of care amounted to an estimated $282 million in unnecessary health care spending in one year.

The report, First, Do No Harm: Calculating Health Care Waste in Washington State utilizes the new MedInsight Health Waste Calculator from the actuarial consulting firm Milliman, to produce an analysis of low-value health care services across the state. The services measured include 47 common tests, procedures, and treatments that clinician-led national initiatives such as Choosing Wisely® and the U.S. Preventive Services Task Force have determined are overused.

Low-value health care services, also called overuse or waste, refers to medical tests and procedures that have been shown to provide little benefit in particular clinical scenarios and in many cases have the potential to cause physical, emotional, or financial harm to patients. Preventing harm associated with the delivery of health care is essential to improving patient safety. While harm is not intentional, it is particularly troublesome when it results from tests, procedures, and treatments that were unnecessary.

“This is a pioneering report for Washington state’s health care community,” said Nancy A. Giunto, executive director of the Washington Health Alliance. “Being able to measure specific areas of waste in the health care system is an important step forward. The results are stunning and provide a clear opportunity to educate patients and engage health care stakeholders on areas of improvement.”

Highlights from the report:

  • This report examined 47 common treatment approaches known to be overused.
  • More than 45% of the health care services examined were determined to be of low value.
  • Approximately 1.3 million individuals received one of these 47 services; among these individuals, almost one-half (47.9%) received a low-value service.
  • 36% of spending on the health care services examined went to low-value treatments and procedures. This amounts to an estimated $282 million in unnecessary spending.
  • Of the 47 treatments and services analyzed, 93% of overuse was attributed to just 11 common tests, procedures and treatments. These include such things as preoperative tests and lab studies prior to low-risk surgery, too frequent cancer screenings, eye imaging tests for people without significant eye disease, annual EKG tests or cardiac screening for people with low risk of heart disease, and imaging for uncomplicated conditions such as low back pain.

Many areas of overuse are individually low cost, but when they are used in high volumes they add up to tremendous waste. “Overuse in the healthcare system has become so common that we frequently don’t even think to question it,” Giunto said. “However, preventing harm to patients is critical, in addition to the fact that everyone pays the price because overuse contributes to higher insurance premiums across the board.”

The MedInsight Health Waste Calculator is an analytic tool powered by Milliman’s MedInsight software and encapsulates VBID Health’s market knowledge on wasteful healthcare spending. The tool identifies and quantifies the use of unnecessary or potentially harmful clinical services, including those defined by national initiatives such as the U.S. Preventive Services Task Force and Choosing Wisely®.

Only two other states in the country have utilized the MedInsight Health Waste Calculator, and only one of them has released results publicly. The public release of the Alliance’s Washington state findings will enable a much-needed community dialogue among key stakeholders about low-value care.

“The MedInsight Health Waste Calculator is a critical tool in the MedInsight suite of analytic products,” said Marcos Dachary, director of product management at Milliman. “We are proud to have worked with the Alliance to produce this vital report about the overuse of health care services in Washington state.”

To help reduce low-value care, physicians and patients should have conversations about appropriate medical care that is both necessary and evidence-based. The national Choosing Wisely® program, an initiative of the ABIM Foundation, offers the following tips to patients.

What can patients do to avoid overuse? Ask these 5 questions before you have a medical test or procedure:

  1. Do I really need this test or procedure?
  2. What are the risks and side effects?
  3. Are there simpler, safer options?
  4. What happens if I don’t do anything?
  5. How much does it cost, and will my insurance pay for it?


  • The measurement year used for the results in this report include services delivered between July 2015 and June 2016.
  • The results in this report are based on an analysis of 47 specific health care services and approximately 2.4 million commercially insured people, and therefore should be viewed as a strong estimate rather than a comprehensive analysis of all health care received by all Washingtonians during the measurement period. Extrapolation of these results to other populations or types of care is not advised.

About the Washington Health Alliance

The Washington Health Alliance is a place where stakeholders work collaboratively to transform Washington State’s health care system for the better. The Alliance brings together organizations that share a commitment to drive change in our health care system by offering a forum for critical conversation and aligned efforts by stakeholders: purchasers, providers, health plans, consumers and other health care partners. The Alliance believes strongly in transparency and offers trusted and credible reporting of progress on measures of health care quality and value. The Alliance is a nonpartisan 501(c)(3) nonprofit with more than 160 member organizations. A cornerstone of the Alliance’s work is the Community Checkup, a report to the public comparing the performance of medical groups, hospitals and health plans and offering a community-level view on important measures of health care quality (www.wacommunitycheckup.org).

Media Contact:

Casey Calamusa
Washington Health Alliance

SOURCE Washington Health Alliance

Where a divided Washington can find common ground: Health care

Our own Jefferson Healthcare is a rural designated hospital.

The Critical Access Hospital lifeline was established in 1997 in reaction to a flurry of rural hospital closures, mostly in Midwest and southeastern states. Some of those closures and consolidations in areas of dwindling populations were healthy, but it threw a scare into small hospitals all over the country.


Legislative Information

The Jefferson County Democrats sent this handy overview out. Hearings are underway for bills already introduced, comment periods are open, and things are moving very quickly.

The legislature’s site for tracking all bills is here:  Bill Information

How you can watch and participate in the legislative process from the comfort of your home. A list of bills being considered by the state legislature was matched up with a Washington State Democratic priorities agenda. It isn’t comprehensive nor does it include all of many important bills being considered but it is a covers a lot (over 80 bills) that are important to Democrats on most issues. The dates and time of bill hearings is generally known a few days in advance only.
The schedule is updated weekly and even daily. You can go here
2018 Bill Hearing Schedule
to find next weeks hearing schedules. That document is always being updated you can keep referring to it for updates.
What you will see, for example:
SB 6034    would allow county PUDs to provide end user telecommunications
When: 1/17   8:00
Comment here
Click on Senate Bill 6034 to learn more about the bill. Click on “Comment here” to leave a comment for the committee in charge of the bill.  “When” is the time the committee has scheduled a hearing on the bill. To watch any hearing on TVW, click on the bill, scroll down to available videos and watch live or later. So bookmark weekly 2018 bill hearings schedule or find it on the website.

Some important bills:

HB 1026 – Health Security Trust. – Appears dead. Not yet out of committee. No hearings scheduled as of 1/26
SB 5701 – Apple Care Trust. – Appears dead. Not yet out of committee. Had hearing on 1/16.
HB 1800 – Voting Rights Act (re-introduced)
SB 6601 – Temporary Medicaid funding to help Grays Harbor and Port Angeles Community Hospitals bridge the fact that the Feds have chosen not to properly reimburse for Medicaid coverage. Hospitals losing money with every patient, and as the old joke goes, “you can’t make it up on volume”.

Looking for WA state bill status?

Here’s a very useful listing of the pre-filed bills for the 2018 session. Sort by various options. Ones with both House and Senate companion bills are most likely to pass or be seriously considered. Any others will need to find companion bills or they will die.


Groundbreaking option in Washington state could let dementia patients refuse spoon-feeding – Seattle Times

Anyone who has watched a terminally ill loved one who refuses to eat, will appreciate this new option. We need to continue to press for death with dignity. If you don’t think this is important you may not have experienced what some homes for the elderly who are mentally not in control will do when they decide that they will keep the patient alive at all costs. This is not a pretty picture of care for the terminally ill, but is all to real today.

A Washington state agency that advocates for medical aid-in-dying has created guidelines for dementia patients who fear losing control not only of their faculties but of their free will to live and die on their terms.