Care & Cost Going Forward

Brian Klepper

On May 13th, I announced that I would merge C&C into The Doctor Weighs In, a process that I have already begun in earnest.

I meant that I would not longer actively aggregate and re-post great health care writing from around the Web. There are other people that do that very well. But I will continue to re-post my writings from elsewhere, and also highlight noteworthy news and thoughts that come my way.

In other words, C&C, in its diminished form, will be a more personal collection of health care observations. I hope you’ll continue to stop by now and then.

Thanks.

Posted in General | Tagged | Leave a comment

Medicare Physician Payment: The RUC’s Hollow Victory

Brian Klepper

Posted 5/18/12 on The Health Affairs Blog

On May 9th, William Nickerson, Senior Judge in the Southern Maryland Federal District Court, issued a 15 page ruling against the six Augusta, GA primary care physician plaintiffs who challenged HHS’ and CMS’ longstanding relationship with the American Medical Association’s Relative Value Scale Update Committee (RUC). The opinion did not weigh the substance of the case, but instead focused on a procedural provision in which Congress bars the judicial system from considering how the relative value units (RVUs) of medical services are determined. Judge Nickerson wrote:

Accepting as true that RUC plays a major role in the formation of the PFS [Physician Fee Schedule] and also accepting as true that this role unfairly skews the PFS toward certain medical professions and procedures, the Court, nonetheless, finds that Congress has precluded courts from reviewing, not only the final relative values and RVUs, but also the method by which those values and units are generated.

Continue reading

Posted in Analytics, Brian Klepper, Health Care Cost, Physicians, Policy/Law/Regulation, Politics | Tagged , , , , | Leave a comment

Care & Cost Merges Into The Doctor Weighs In

Brian Klepper

When I began Care & Cost in December of 2010, the idea was to aggregate consistently good health care writing, and to moderate the comments to ensure a courteously professional exchange on the site.

It has been a pleasure and even an honor to scour health care blogs of all types early each weekday morning. Wonderfully dedicated and thoughtful colleagues – Merrill Goozner, Kenny Lin, David Harlow, Wendy Lynch, Brad Flansbaum, Bill Bestermann, Jane Sarasohn-Kahn, Paul Levy, Jaan Sidorov, Tom Emerick, Bob Laszewski, Roger Collier, and many more – graciously allowed me to republish their work. The result, I think, has been a cornucopia of high quality insight and knowledge.

Being dedicated to the exercise let me build a faithful readership that included professionals of all political and philosophical persuasions, who vigorously disagreed at times, but always with respect.

Even so, my own schedule has intensified, and maintaining C&C has become more difficult day-to-day. I’m very involved in the development of WeCare TLC, a leading edge onsite clinic and medical management firm. I’ve helped to spearhead the campaign against the current structure of the AMA’s Relative Value Scale Update (RUC) and that organization’s corrosive relationship with CMS. I’m continuing to write, now as a Medscape columnist on Business of Medicine and Primary Care, as well as for other venues. And I’m devoted to the struggle to deal with my wonderful wife Elaine’s peritoneal (ovarian) cancer.

I’ve chosen to fold into The Doctor Weighs In (TDWI) for several reasons. Perhaps most important, it reflects approximately the same sensibility – and possibly a more expansive one – on the kinds of content that a good professional health care magazine should be running. TDWI’s founders and editors are my very close friends Pat Salber, MD MBA and Dov Michaeli, MD PhD, both writers and thinkers whose work I hugely admire. Over the past several months, we’ve often posted the same columns.

So I urge you to head over there and sign up for their morning email. I am deeply grateful and humbled that you chose to spend time with me trying to better understand the many complexities that have made American health care so interesting and vexing.

Thank you for coming. Let’s continue this conversation over at TDWI.

Posted in Brian Klepper, General | Tagged , , , , | 5 Comments

The RUC’s Empty Gesture

Brian Klepper and Paul Fischer

Posted 05/11/2012 on Medscape Business of Medicine

Recently, the leaders of the American College of Physicians (ACP) and the American Geriatrics Society (AGS) lavished praise on the American Medical Association’s Relative Value Scale Update Committee (RUC) for announcing the addition of a rotating primary care seat and a permanent geriatrics seat, and for promising to post vote tallies. Welcoming these maneuvers indicates not only a poor understanding of history but also misguided political and strategic instincts that will continue to harm patients, purchasers, and primary care physicians.

Continue reading

Posted in Brian Klepper, Health Care Cost, Medical Management, Physicians, Policy/Law/Regulation, Politics, Quality | Tagged , , , , | Leave a comment

Second Opinions: How Should You Choose?

Dov Michaeli

Posted 5/9/12 on The Doctor Weighs In

Incredulous Dov

I have frequently been asked to render judgment on another doctor’s diagnosis, or treatment plan. Other times I am asked anxiously: “should I get a second opinion”? The implicit assumption in this sort of questions is that “two heads are better than one.” Or stated more broadly, we put our faith in the “wisdom of the crowd,” whether the “crowd” is made up of two or two-thousand individuals.

I have to admit I’ve had some nagging doubts about this all-encompassing wisdom. For instance, wisdom of the crowd has been amply documented in estimation tasks (“how many people in this crowd?  What is your estimate of the completion date of the project?”). The reason this works is that it exploits the benefit of error cancellation; the outlier estimates on either side cancel out each other and we end up with the consensus opinion, that is closest to the truth. But how do you decide when the issue is not quantitative? Think of the virtually unanimous opinion of the White House crowd to go to war in Iraq. Where was the “wisdom” there? More interesting, we could drill deeper and ask why is it that the crowd reached such a wrong decision? Wisdom of the crowd was hailed as a source of near-magical creativity and unparalleled wisdom and forecast accuracy. Some of these attributions have proved to be unfounded. For instance, with respect to creative potential, groups that engage in brainstorming lag hopelessly behind the same number of individuals working alone. The key to benefiting from other minds is to know when to rely on the group and when to walk alone. Wouldn’t it be nice if we had some sort of an algorithm to guide us in making this decision?

Continue reading

Posted in Life Sciences, Medical Management, Physicians | Tagged , , | Leave a comment

DeathWise.org – DIY End of Life Planning

Pat Salber

Posted 5/10/12 on The Doctor Weighs In

For most of us, talking about death doesn’t come easily. Yet, it’s something we all experience — the loss of those we know and love, and ultimately, our own death - quote from DeathWise.org

In this wonderful age of digital empowerment, we can now take charge of many things that we used to have to depend on others to do for us.  Examples include booking vacations and managing our investment portfolios. Now, there is a website, DeathWise, that can help you manage your death–well, not exactly your death, rather the planning for your death.  This can mean the difference between an orderly exit or one that leaves your family and friends combing through your papers and guessing your wishes.

In my family, no one ever talked about death, let alone planned for it. One example was the death of my maternal grandmother who, at the age of 78, died in her bed in the apartment she had rented for almost 40 years. Neither her daughters, their spouses, nor the rest of her extended family had any idea about the details of her life despite the fact that we all lived within 30 miles of her house and saw her frequently. We were pretty surprised to find out that all of “her” furniture actually belonged to the landlord.

And, that her frugal habits included saving every rubber band that ever made it into her hands – all rolled up into a gigantic rubber band ball. We didn’t know where her papers were, what type of service she would like or even if she preferred cremation or burial. We muddled through, spending days in her apartment opening cupboards, poking around in drawers, and rifling through papers, bankbooks (remember them?), and check stubs. We hoped we did what she would have wanted, but we weren’t really sure.

Continue reading

Posted in Consumerism, Medical Management | Tagged , , , | Leave a comment

Implementing Health Reform: Increasing Medicaid Payments for Primary Care Physicians

Timothy Jost

Posted 5/10/12 on the Health Affairs Blog

On May 9, 2012, the Center for Medicare and Medicaid Services released proposed regulations to implement section 1202 of the Health Care and Education Reform Act of 2010. Section 1202 increases Medicaid payments made to primary care physicians for primary care services during the years 2013 and 2014 to Medicare payment rates, with the additional cost covered by the federal government.

Continue reading

Posted in Health Care Cost, Medical Management, Physicians, Policy/Law/Regulation, Politics, Reform | Tagged , , , | Leave a comment

The Maryland Federal District Court Rules Against The Georgia Physicians’ RUC Challenge

The ruling was issued yesterday, and is a disappointing resolution to a very large national problem. I’ll write more about this in the next few days. Here is Judge Nickerson’s decision, for those interested in reading it.

Posted in General | Leave a comment

Patent Pools Pushed To Make Drugs Affordable in Developing World

Merrill Goozner

Published 5/9/12 in The Fiscal Times

Amid a growing crisis in financing treatments for AIDS, tuberculosis and malaria in the developing world, an arm of the World Health Organization will meet in Geneva later this month to consider alternative ways of producing lower-cost drugs, vaccines and diagnostic tools to fight the those diseases in poor countries.

A background report issued last month by a working group of the World Health Assembly called for establishing a global research and development treaty that would beef up research into cures for so-called neglected tropical diseases. It also called for the treaty to create mechanisms for ensuring the next generation of drugs for fighting those diseases could be produced by generic firms at prices barely above the cost of manufacturing.

Continue reading

Posted in Health Care Cost, Innovation, Market Dynamics, Medical Management, Physicians, Policy/Law/Regulation, Politics, Tools | Tagged , , , , | Leave a comment

Looking Beyond the Money: Crucial Steps to Getting Vaccines to Children

Lois Privor-Dumm

Posted 5/8/12 on Disruptive Women in Health Care

looking-beyond-the-money-crucial-steps-to-getting-vaccines-to-childrenWithout money, many nations can’t afford to tackle health care issues and introduce the life-saving vaccines that are critical to child survival in the developing world.  But even after a vaccine is introduced and money has been spent, some children never see even the first dose.  With so much investment and effort, you wonder — how can that be?

Take Nigeria, the country with the second largest number of child deaths globally.  Over the past few years, they’ve raised vaccine coverage in many parts of the country to nearly 70%.  But progress is fragile, and results uneven.  Some areas have coverage rates above 80%; others are barely providing any vaccine.  Economic status and presence or absence of donor funding don’t fully explain the disparities. It’s not just the money – there must be something more.

Continue reading

Posted in Health Care Cost, Innovation, Market Dynamics, Medical Management, Physicians, Politics | Tagged , , , | Leave a comment

Whatever It Is, It’s Not Insurance

Tom Emerick

Posted 5/9/12 on Cracking Health Costs

Discussions about covering “pre-existing” health conditions occur frequently among health policy people. One frequent thread is that health insurers should not be allowed to deny coverage to people with pre-existing health condition. After all, aren’t those the people who need health insurance the most?  Sounds reasonable, doesn’t it?  Problem is that proposition is really not reasonable.

Let me explain.  For any kind of insurance to work right, the “contingent event” can not have already happened before you buy it.  In life insurance, the contingent event is the death of the policyholder.  You can’t buy life “insurance” on someone who has already died.  For homeowners insurance, you can’t buy fire insurance after the home has burned.

Continue reading

Posted in Analytics, Benefits, Health Care Cost, Innovation, Market Dynamics, Policy/Law/Regulation | Tagged , , | 1 Comment

Sue the Patient

Dan Munro

Posted 4/27/12 on Forbes

States often confer the tax-exempt status on hospitals with the expectation that certainly some services will be extended to the less fortunate with limited capacity to pay. Two of the more litigious hospitals in North Carolina are Carolinas HealthCare and Wilkes Regional Medical Center in North Wilkesboro. They each filed over 12,000 lawsuits against patients in the same five-year period. One of the controlling entities – Carolinas HealthCare System – reported annual profits of more than $300 million over the last three years. One facility, Carolinas Medical Center-Mercy (CMC-Mercy) promotes itself as a “Planetree Designated Patient-Centered Hospital.” Planetree, Inc (itself a non-profit) offers tiered designations (Bronze, Silver and Gold) for “achievement in patient-/person-centered care based on evidence and standards.” The designation appears to be loosely based on an “application review fee” ($2,500 – $5,000) and includes a “self-assessment.” CMC-Mercy’s Gold Designation status is prominently featured on the hospital’s website:

CMC-Mercy – Planetree Gold Designation

Continue reading

Posted in Analytics, Consumerism, Market Dynamics, Medical Management, Policy/Law/Regulation, Quality | Tagged , , , , | 2 Comments

Barking Up the Wrong Tree: Affordability, Not Cost Growth, Is The Real Policy Challenge

Jeff Goldsmith

Posted 5/7/12 on The Health Affairs Blog

A recent spate of commentaries on the continuing health spending moderation raise an important policy question:  If the cost curve is well and truly bent, why are we investing so much of our policy energy on bending it further, when the more pressing problem is the declining percentage of Americans that can afford our health system’s astronomical costs?

Health spending the past two reported years (2009 and 2010) have grown in the high 3 percent range, the lowest growth rates since Dwight Eisenhower’s last year in office (1960), five years before Medicare.Medicare’s actuaries have pointed to the recession as a root cause.  Yet even Medicare spending growth has subsided to about 5 percent in 2010, a  development hard to attribute to recession since so few Medicare patients have first-dollar cost exposure. This analyst’s extensive industry contacts suggest no spending rebound in 2011 and 2012, despite an aging population and fee-for-service’s pernicious volume-increasing incentives in full force.

Continue reading

Posted in Analytics, Benefits, Consumerism, Health Care Cost, Imaging, Innovation, Policy/Law/Regulation, Politics, Supply Chain | Tagged , , , | Leave a comment

Why US Health Costs are Higher Than Anywhere Else in the World

Jane Sarasohn-Kahn

Health Populi

The price of physician services, proliferation of clinical technology and the cost of obesity are the key drivers of higher health spending in the U.S., according to The Commonwealth Fund‘s latest analysis in their Issues of International Health Policytitled, Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality, published in May 2012.

The U.S. devotes 17.4% of the national economy to health spending, amounting to about $8,000 per person. The UK devotes about 10%, Germany 11.6%, France, 11.8%, Australia 8.7%, and Japan, 8.5%.

On the physician pay front, primary care doctors in the U.S. earn about $186,000 a year, compared with Australian colleagues who bring in about $92K a year, French peers at $96K per annum, Canadian PCPs earning $125,000, Germans at $131K, and British earning $160K.

Continue reading

Posted in Analytics, Policy/Law/Regulation, Market Dynamics, Medical Management, Quality, Physicians, Politics, Health Care Cost | Tagged , , , | 2 Comments

You Can Unleash This Horsepower!

Paul Levy

Posted 5/6/12 on Not Running a Hospital

Among the great hospital leaders in America, Jeffrey Thompson, CEO of the Gundersen Lutheran Health System in Wisconsin, stands out for going beyond achieving marvelous results in patient quality and safety.  Jeff’s commitment that his system will not accept mediocrity shows up in other arenas as well.  He and his board have adopted a corporate strategic plan that sets a goal of being “the best regionally and nationally on environmental stewardship and accountability.”

This is outlined in a recent keynote speech he gave at CleanMed 2012 in Denver.  Jeff pointed that hospitals have a large impact on the environment and on public health because of their use of electricity.  Noting that his system alone produces 500,000 pounds annually of airborne particulates tied to its electricity consumption, he concluded that reducing that impact can and should be tied into the culture of a health care institution.  He asserted, “We are going to be responsible to members of the community.  We are going to be transparent, and we are going to act to fix things.”

Continue reading

Posted in Health Care Cost, Innovation, Market Dynamics | Tagged , , | Leave a comment