Christian; dad; ED doc @ucsfdem; via @emhpolicy @yaleem2; tweets on access, care transitions, health insurance, and more; views are my own
Joined October 2016
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The latest in health insurers trying to practice medicine:
journals.lww.com/em-news/ful…
A milestone worth commemorating. This is 4+ years of revisions w/ 10+ rejections from various funders.
Too many to thank, but particularly the wonderful mentor team of @Jwharam @JSchuurMD @ScottWeinerMD @ReneeYHsia, and the support of @BWHEmergencyMed @ucsfdem @HealthPolicyDPM
Also excited to start a new position at @ucsfdem! I know I will miss Boston and have @BWHEmergencyMed to thank for the past several years as I matured as a clinician and researcher.
One of those things you'd think we don't need a trial to show... But sadly we do.
New 📝 out of Canada.
“The findings support a recent call for pharmacoequity, or access to high-quality 💊💊, ‘regardless of race & ethnicity, socioeconomic status, or availability of resources” by demonstrating economic benefits of fair access.”
jamanetwork.com/journals/jam…
Officially offline from @BWHEmergencyMed. Special mention to @ScottWeinerMD, @JSchuurMD, @PeterRchai, the numerous Andrews' and many more who have been a friend to me.
See you all around :)
AMCs transfer admitted patients to community hosp for capacity management.
NHB and Hispanic pts were more likely to be deemed eligible for transfer by MDs and more likely to consent to transfer.
Raising Q on systemic bias & need for levers to mediate.
#SAEM23 @EMRES_MGHBWH
Andrew Chou retweeted
180% in utilization of ED observation stays over from 2006/7 - 2018/9. #Neurology complaints were an important driver. Great work by Andrew Luo. @EMRES_MGHBWH @AChouMD
Higher hospital surge preparedness is associated with over one third reduction in excess mortality.
#SAEM23 by @AlexJankeMD @arjunvenkatesh
Cc @jeremyfaust
Andrew Chou retweeted
My name is Muhil, and I first came to the United States when I was 2 years old. Despite living here lawfully for two decades, I did not receive my green card with my family because I aged out.
Andrew Chou retweeted
“This leaves us as a society with an important and difficult question—how we will we survive if you go into an emergency department, and there are no doctors or nurses left to care for you? “ Janice Blanchard scientificamerican.com/artic…
Andrew Chou retweeted
Doctors at a major US insurance company deny tens of thousands of claims a month without even looking at patients’ files.
“We literally click & submit,” a former Cigna doctor told @ProPublica & @Capitol_Forum. “It takes all of 10 seconds to do 50 at a time.”
The inside story 🧵
This is pretty much the only reason for denial and pre-authorization--it's more likely people will just go without insurance or forego care, leading to more profits for insurers.
14/ In one corporate document, Cigna estimated that only 5% of people would appeal a denial resulting from a PXDX review.
ALT Screenshot of internal Cigna presentation. Highlighted is the last line of the grid, which reads "Estimated Appeal Volume (Based on previous or similar experience): 894 (5% appeal rate assumption)
Andrew Chou retweeted
14/ In one corporate document, Cigna estimated that only 5% of people would appeal a denial resulting from a PXDX review.
ALT Screenshot of internal Cigna presentation. Highlighted is the last line of the grid, which reads "Estimated Appeal Volume (Based on previous or similar experience): 894 (5% appeal rate assumption)
Andrew Chou retweeted
Point is, no insurer has ANY incentive to lower health care costs. The more we all spend on health care, the more high premiums are justified, and the bigger their 20% slice of the pie can be.
Come back in a few years, and I promise @AjKavanaugh’s numbers will be even higher.
Great following the discussion, but the defense to insurers' PA or denials overlooks (or downplays) the fact that commercial insurance companies have one mission only--maximize profits.
I have mixed feelings about this @propublica piece. No question UnitedHealth looks very bad.
But what are insurers supposed to do for unusual, extreme medical use? Often it is not justified at all. The costs are then just passed on to us.
propublica.org/article/unite…
That said, there are alternatives! Bundled payment comes to mind. Global budget is another. Obviously, I'm oversimplifying. The point is there are ways to control costs without relying on insurers to judge medical decisions.