Rationing Redux: The Dog That Didn’t Bark

Merrill Goozner

Published 4/10/12 in The Fiscal Times

Last week, physician groups representing nearly half of America’s doctors issued guidelines that would limit Americans’ access to allegedly unnecessary medical tests and procedures. The public reaction was noticeable for the one thing that was missing – a public outcry against rationing.

That was reserved for the floor of the U.S. House of Representatives on a completely separate issue. The Republican majority last week cast another symbolic vote against what it calls rationing in the health care reform law better known as Obamacare.

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How To Get Better At Harming People Less

Paul Levy

Posted 4/09/12 on Not Running a Hospital

Every day, a 727 jetliner crashes and kills all the people on board.  Not really.  But every day in America, the same number of people in American hospitals lose their lives because of preventable errors.  They don’t die from their disease.  They are killed because of hospital acquired infections, medication errors, procedural errors, or other problems that reflect the poor design of how work is done and care is delivered.

Imagine what we as a society would do if three 727s crashed three days in a row.  We would shut down the airports and totally revamp our way of delivering passengers.   But, the 100,000 people a year killed in hospitals are essentially ignored, and hospitals remain one of the major public health hazards in our country.

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Moving Beyond Merchant Health Care

Brian Klepper

Published 4/05/12 on MedPage Today

Another luminary-rich panel has been formed to make recommendations about how physician and other healthcare services should be valued and paid for.

The Society for General Internal Medicine launched the National Commission on Physician Payment Reform with funding from prominent healthcare foundations. The 13 commissioners represent a mix of perspectives: a former surgeon/senator, community physicians, academics, two healthcare mega-corporations, a think tank, a state regulator, and a reform-oriented advocacy organization. A group representing large employer purchasers has one seat.

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Can We Squeeze the Waste Out Of Medical Education

Patricia Salber

Posted 4/04/12 on The Doctor Weighs In

I had a chance to “moonlight” in the internal medicine “drop-in” clinic at the Kaiser Medical Center in San Francisco while I was finishing my residency and endocrinology fellowship at UCSF.  I was superbly trained in in-patient care and there was no IV or PA line that I couldn’t put in with my eyes closed.  I was comfortable taking care of really sick people and thrived on complex, acute cases.  I knew how to work up a VIPoma (vanishingly rare endocrine tumor), but, I didn’t know how to treat a paronychia (a skin infection around the nails) and I was bored silly by colds and sore throats – the run of the mill cases that filled up the Kaiser clinic.  I used to daydream about building a machine that would grab (gently) the patient by the neck, insert a throat swab, and then spit out a prescription for penicillin.   Nine years of training for this!  What a waste of all that training!

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Patient Engagement and Medical Homes – Core Drivers of a High-Performing Health System

Jane Sarasohn-Kahn

Posted 3/30/12 on Health Populi

It was Dr. Charles Safran who said, “Patients are the most under-utilized resource in the U.S. health system,” which he testified to Congress in 2004. Seven years later, patients are still under-utilized, not just in the U.S. but around the world.

Yet, “when patients have an active role in their own health care, the quality of their care, and of their care experience improves,” assert researchers from The Commonwealth Fund in their analysis of 2011 global health consumer survey data published in the April/June 2010 issue of the Journal of Ambulatory Care Management. This analysis is summarized inInternational Perspectives on Patient Engagement: Results from the 2011 Commonwealth Fund Survey, published on The Commonwealth Fund’s website on March 29, 2012.

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Great News! Medicare Tightening Up At Last

Tom Emerick

Posted 4/3/12 on Cracking Health Costs

Good news on the Medicare front.  In a few states (FL, CA, MI, TX, NY, LA, IL) they are at last tightening up on unnecessary surgical procedures, according to a news story in Forbes.  Hurray!

According to the story, “In 2012 CMS will perform an audit before paying for several big ticket cardiology and orthopedic procedures in certain key states.”  All I can say is, at last.

This is huge news.  If Medicare takes this seriously, and gets the results it should get, it will be a great step forward in advancing evidence-based medicine in the public sector.  Further, it will pave the way for employer-sponsored plans to be more aggressive in dealing with over-surgery.  Readers of Cracking Health Costs know that I’ve been tough on Medicare for looking the other way over unnecessary surgery for decades.  May the day come when I can take it all back.

Predictably surgeons are unhappy.  Most surgeons have had no accountability to anyone for getting diagnoses right or doing surgery only when truly necessary.  They will vigorously resist such accountability.  However, such accountability is the norm in most industrialized nations.  That lack of accountability here is one of the main reasons why we spend so much more on health care than our peer nations but get worse and worse results.  Accountability needs to be the norm here too.

Plus Wall Street doesn’t like the idea either.  “Reaction to the report on Wall Street was immediate.  Hospital and medical device stocks plunged after the report was issued on Friday….”  Hmm.  My theory is Medtronic’s stock price is inversely related to America’s economic health.

This is a good test to follow as it is a battle between evidence-based medicine and profit-driven medicine. To see the full article, click here.

Free Our Data and Improve Public Health!

Paul F. Levy and W. David Stephenson

Published in the current issue of the Boston Business Journal

Massachusetts has a stunning opportunity to break open many of the mysteries surrounding delivery of health care. Doing so will help resolve important public policy issues. It will help contain rising health care expenses. And, it will even help save lives and improve the public health.

Doing this requires no new state law. The law is already on the books. It requires no addition to the state budget. The costs have already been incurred.
What could cause so dramatic an impact? Liberating data that is already in the hands of the state government.

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Pay Some Doctors More to Save Money

Paul Levy

Posted 3/26/12 on Not Running a Hospital

One of the strange things about health care in America is the manner in which decisions are made about how different kinds of doctors should get paid for their services.  It turns out that the system is controlled in a way most consumers would find unbelievable. As noted by the Wall Street Journal:

 

Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars.

The group, convened by the American Medical Association, has no official government standing. Members are mostly selected by medical-specialty trade groups. Anyone who attends its meetings must sign a confidentiality agreement.

Yet the influence of the secretive panel, known as the Relative Value Scale Update Committee, is enormous. The Centers for Medicare and Medicaid Services, which oversee Medicare, typically follow at least 90% of its recommendations in figuring out how much to pay doctors for their work. Medicare spends over $60 billion a year on doctors and other practitioners. Many private insurers and Medicaid programs also use the federal system in creating their own fee schedules.

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Workers’ Comp Medical to be Federalized

And For Our April Fools Edition!

Joe Paduda

Posted 4/1/12 on Managed Care Matters

While all of Capitol Hill was focused on the hearings on ObamaCare at the Supreme Court, the Administration was quietly proceeding with plans to federalize the medical portion of workers’ compensation. The effort has reportedly been led by Assistant Deputy Secretary A. Pryl Pfuelle who has been working closely with the Executive Secretariat on policy implications and coordination efforts. Details on timing, rollout, reimbursement levels and other critical matters are still to be worked out, but the Secretariat is likely looking to FECA as the regulatory agency that will be tasked with oversight responsibilities.

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Should Family Physicians Leave the RUC?

Brian Klepper

Posted 3/30/12 on KevinMD

Last June the American Academy of Family Physicians (AAFP) sent a letter to the AMA’s Relative Value Scale Update Committee (RUC) demanding specific changes to the ways that the RUC conducts its business. Primary care has been severely compromised by the RUC’s recommendations, and there was an implicit threat that the nation’s largest medical society would withdraw if the demands were ignored.

I co-authored a Kaiser Health News article in January 2011 calling on AAFP and other primary care societies to quit the RUC. The campaign was given real teeth when six Augusta, GA primary care physicians filed suit last June in a Maryland federal court against the US Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS). The complaint charges that those agencies have refused to require the RUC to adhere to the stringent requirements of the Federal Advisory Committee Act, which ensures that policy is formulated in the public rather than the special interest.

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Day Three – The Wrap Up

Merrill Goozner

Posted 3/29/12 on Gooz News

This is what conservative justices will do if they strike down or cripple the health-care law … A court that gave us Bush v. Gore and Citizens United will prove conclusively that it sees no limits on its power, no need to defer to those elected to make our laws. A Supreme Court that is supposed to give us justice will instead deliver ideology. now  – E.J. Dionne, The Washington Post

The insurance mandate was effectively reduced to a bumper sticker by the opponents in their constitutional challenge, and the entire law reduced to little more than an appendage to the mandate. . . The fate of the mandate should not determine the survival of the other elements of the law — like prohibiting insurers from denying coverage to people with pre-existing conditions or charging them higher fees — which can operate without the mandate. – New York Times editorial

Overturning the whole law would be an act of judicial restraint. – The Wall Street Journal editorial

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Health Reform: An Amicus Brief for the Court of Public Opinion

C. Eugene Steuerle

Posted 3/23/12 on the The Government We Deserve

The Supreme Court will consider the constitutionality of the Affordable Care Act at the end of the month. We the public should be appalled.

It’s not that each side can’t come up with some good constitutional arguments. It’s that the suit is totally unnecessary, caused largely by the unwillingness of the major political parties to work together on anything. Like a divorce between two parties more invested in their fight than in the effect on those around them, it belongs in a domestic relations court that would refer the parties to a mediator.

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The Right Rx for Better Health Care: Rise Up to Challenge the Industry’s Lobbying Power

Brian Klepper and Shannon Brownlee

Published 3/29/12 in the New York Daily News

Obamacare had its days in the Supreme Court this week, and the justices’ decision could have sweeping consequences for the individual mandate provision in the Patient Protection and Affordable Care Act, and maybe even for the fate of the law itself.

Yet whatever the court decides, we will still be stuck with a problem that this contentious law was not likely to solve on its own: an out of control health care industry that threatens the stability of the U.S. economy and the federal government’s ability to deal with our long-term debt.

Continue reading “The Right Rx for Better Health Care: Rise Up to Challenge the Industry’s Lobbying Power”

If the Supreme Court Overturns the Individual Mandate

Robert Laszewski

 Posted 3/28/12 on Health Policy and Marketplace Review

First, trying to predict how the Court will rule is at best just speculation. I know what Justice Kennedy said both today and yesterday and it certainly doesn’t look good for the Obama administration and upholding at least the mandate.

But I will remind everyone, based upon oral arguments, most Court watchers expected a ruling in favor of the biotech industry on a recent case involving health care patents. “Surprisingly,” the Court ruled against the industry.

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The Mandate May Fall, But Not Reform

Merrill Goozner

Posted 3/24/12 on Gooz News

Opponents of health care reform, whose case will be heard next week by the Supreme Court, base their complaint against the Obama administration’s signature domestic achievement on the claim that its individual mandate to purchase health insurance is unconstitutional.

Challengers, including state attorneys general and governors in a majority of states, say it represents an unwarranted extension of the constitution’s commerce clause into the personal realm of individual choice. If people do not want to buy a particular product – in this case health insurance – the government has no right to make them.

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