Below, a post that caught my eye on Kevin M.D. 

Kevin M.D. is a blog that I have long admired–extremely intelligent, timely and written from a physician’s point of view.  (Full disclosure: from time to time, Kevin cross-posts pieces from HealthBeat)

What Dr. Jan Gurley (who writes for Reporting on Health, a USC Annenberg School of Journalism online community for journalists and thinkers), has as to say about our “new, laughably flawed, multi-million-dollar ‘client satisfaction’ industry,”  strikes me as both provocative and a fair warning: Inevitably, health care reform will attract profiteers. As Gurley puts it:  “We’re letting anyone and everyone game the system.”                      ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~                    

Why Popularity Based Payment for Doctors is Not the Answer

by Jan Gurley, MD

Perhaps you remember Sam, the chronic inebriate whose story I shared to discuss the pitfalls of basing doctor pay on patient satisfaction surveys.

Looking at his discharge papers, I wondered who helped Sam fill his survey out, and how much their “help” affected the results.

After all, millions upon millions of dollars are already now at stake for hospitals. And individual doctors’ Medicare payments are expected to be based on their satisfaction scores, as early as the year 2015.

Surely these surveys are validated and standardized, right? Surely there is policing to prevent “helping” people fill them out? You might be surprised by the answers to those questions.

Continue reading →

It was only a matter of time. Eventually, Medicare would refuse to continue paying drug-makers whatever they choose to charge.  Now, it appears that this is happening.  (Kudos to Igor Volksky over at Think Progress Health.)

In 2006 when the Bush administration expanded Medicare to cover prescription drugs, it included a gift to drug companies that specifically prohibited the government from directly negotiating on drug prices.

Four years later, when health care reformers were trying to push a politically prickly piece of health reform legislation through a deeply divided  Congress, they didn’t try to reverse that provision. It just wasn’t the time to try to take on Pharma. Too many legislators are beholden to the industry for campaign contributions. As it was, the Affordable Care Act barely made it through Congress.

Nevertheless, some liberals groused that the administration had made a “deal” with Pharma.  As I wrote at the time, I very much doubted that the president had pledged that Medicare would never, ever ask for lower drug prices. I also assumed that sometime between the spring of 2010, and the beginning of 2014, reformers would revisit the issue. The Affordable Care Act was, and is, a work-in progress.

Then, in April, as Naomi reported here on HealthBeat, President Obama put the idea of letting Medicare using its clout to secure lower drug prices “back on the table.” 

“During a speech at George Washington University, President Obama revealed that one of the ways he plans on cutting Medicare costs will be to cut government spending on prescription drugs by $200 billion over the next ten years.”  With this statement, Naomi observed, “Obama seems to suggest that he wants Medicare to . . . start negotiating prices directly with pharmaceutical companies, something the Veterans Administration, for one, has been doing for years.”  (And, I would add, with great success.)

                 Pharma Becomes Part of the Mix in Debt Negotiations

Late this afternoon, Igor Volsky reported that the president has now opened the door to slicing Medicare’s drug bill. 

Continue reading →

             
While negotiating with Republicans, President Obama has made it clear that he is not willing to cut services to Medicare patients. But he will consider trimming payments to nursing homes.  

Wait a minute—doesn’t that mean fewer services for nursing home patients? Not necessarily.

                  Fat Profit Margins

Over the past ten years, investment groups have been gobbling up nursing homes. By 2008, over 67 percent were operating “for profit.”  And insofar as that is their mission, they have succeeded, handily. The Medicare Payment Advisory Commission’s (MedPAC’s), March 2011 report to Congress notes that “In 2009, the average Medicare [profit] margin for freestanding Skilled Nursing Facilities (SNFs) was 18.1 percent.  . . We examined relatively efficient SNFs,” the report adds, “and found that it is possible to have costs well below average, above-average quality, and more than adequate Medicare margins.”

In other words, there is money to be saved within the nursing home sector without undermining patient care.

Continue reading →

Conservatives call it the “malpractice crisis.” Public Citizen, a liberal non-profit consumer organization based in Washington D.C., calls it “The Great Medical Malpractice Hoax.”

No doubt you have read that ambulance-chasing lawyers have escalated their assault on health care providers, and that as a result, malpractice insurance premiums have been levitating, along with malpractice suits, further hiking the cost of medical care.

Various solutions have been floated, including “caps” on compensation for pain and suffering; “health courts” where expert judges replace juries; immunity for doctors who follow “best practice guidelines;” and “full disclosure” policies which urge doctors and hospitals to move quickly to disclose errors, apologize, and offer compensation.

In the end, the best solutions would make malpractice reform part of heath care reform. Our malpractice system should be redesigned to reduce medical mistakes, fully compensate patients who are injured by human error, reward doctors and hospitals that disclose errors, and penalize those that try to "cover up." When it comes to the cost of malpractice, reform should slash the exorbitant administrative costs built into an adversarial process that moves at a snail’s pace, while subjecting both plaintiffs and defendants to what a recent report from the American Enterprise Institute rightly describes as “inhumane.”

Continue reading →

A few days ago, I found myself involved in a debate over malpractice suits on The Heath Care Blog. One reader on the thread explained why, in his view, we need some type of tort reform: “What drives physicians to practice defensive medicine is the total lack of objectivity, fairness and consistency both across jurisdictions and even within a jurisdiction as to how medical disputes are decided.  Juries of lay people who cannot understand the often conflicting scientific claims in these cases can be easily swayed by emotion and sympathy for injured plaintiffs.

 “The inclination to practice defensively is especially prevalent in ER’s when the doctor and the patient often don’t know each other and there is time pressure to determine a diagnosis and send the patient on his or her way,” he added. “I’ve heard from plenty of doctors who work in inner city ER’s that even poor people are not shy about suing when there is a bad outcome if they can find a lawyer to take their case which they often can.”

This comment pretty well sums up the conventional wisdom about medical malpractice cases:  Juries are not objective, don’t understand the evidence, and tend to sympathize with the patient. Meanwhile, doctors should be wary of those low-income patients in ERs. Americans are litigious by nature and if patients are not entirely happy with the outcome, they’ll jump at an opportunity to turn misfortune into a payday. Poor people, who need the money, are even more likely to try to “score.”

Those are the fictions.

 Here are the facts, according to Drs. John Glasson, and David Orentlicher, writing in JAMA: 

Continue reading →

Do Teaching Hospitals Lose Money or Turn a Profit on Residents?

Uwe Reinhardt writes a provocative post about medical education in today’s New York Times.

He begins by calling attention to “Why Medical School Should Be Free,” a recent commentary in the New York Times, by Peter B. Bach, M.D., and Robert Kocher, M.D., which proposes that medical school be tuition-free for all students. (Dr. Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan-Kettering Cancer Center, was a senior adviser at the Centers for Medicare and Medicaid Services in 2005-6; Dr. Kocher is a guest scholar at the Brookings Institution and was a special assistant to President Obama on health care and economic policy in 2009-10.)

Back and Kocher estimate that the annual tuition for medical students would be roughly $2.5 billion, and—here is what I found most interesting—that equals only about 0.017 percent of GDP or $15 trillion.  In other words this society could afford to subsidize medical education for all students who manage to make it into med school.

Continue reading →

Find Hospitals in Your State on the Map from Consumer Reports Below

Summary:  Consumer Reports Health (CRH) has just released a report showing wide variation in how likely it is that a hospital patient will pick up a deadly bloodstream infection. Much depends on the culture of the hospital the patient chooses. Does the head of the intensive care unit insist that doctors and nurses all follow a protocol to prevent these infections? Does the hospital administration back him up? The CRH review of more than 1,000 hospitals show that 142 have reduced infections associated with central line catheters to zero. Only two of the 142 are academic medical centers. Why?

In a telephone interview John Santa, M.D., M.P.H., director of the Consumer Reports Health Ratings Center, explains the shocking fact that these infections are, accepted within the “standard of practice.” What would it take to change the standard of practice? “Doctors testifying in a malpractice suit.” I would like to think there an easier solution.

Continue reading →

First it was Aetna. Now Blue Shield of California is doing the right thing. Who will be next? Health Insurers are beginning to slice premiums and rebate money to customers.

Last year, many of health care reform’s critics (on the left as well as on the right), argued that the Obama administration had made a “deal” with the private insurance industry, giving it carte blanche to continue driving health care costs skyward.

I disagreed. Certain tough provisions in the Affordable Care Act (ACA) suggested that the insurance industry was not dictating the terms. In particular, the requirement stipulating that insurers pay out 85 percent of the premiums they receive in reimbursements to doctors, hospitals and customers signaled that insurers were not holding the pen while legislators pretended to write the bill. Under the ACA, if insurers do not meet this standard, they will have to rebate hundreds of millions to their customers. Now, this is beginning to happen.

(Insurers must pay out only 80 percent of premiums when offering insurance to small groups because in these cases, insurers' administrative costs, as a percentage of revenues, are so much higher. But this, too, will crimp net income.)

Continue reading →

  Alzheimers – Could it be Over – diagnosed?

 Are Docs in Danger of Becoming “Slaves”

 Maybe Insurers' Profits Are Not So Big After All?

 Is the Affordable Care Act Part of the Answer to the Medicare ‘Crisis’?

 Despite Chaos in Washington, is Reform Moving Ahead According to  Plan?

 Should We Eliminate Co-Pays for Cancer Drugs?

 Are Hospitals Hyping Robotic Surgery for Prostate Cancer?

  IT Vendors and eRX – -Is the Juice Worth the Squeeze?

  Racial Disparities: When African-Americans Have a Stroke Why Do Many Call A Friend First?

  When Patients with Health Savings Accounts Spend Less, & Skip  Immunizations for Kids, Is This A Virtue or a Vice of HSAs?

Should the Private Sector Sink $$$ into a War on Poverty?

                             ~~~~~~~~~~~~~~~~~~

On the Heath Affairs’ blog, Chris Fleming hosts the most recent edition of Health Wonk Review—a rich round-up of some of the best health care posts of the past two weeks.  Below, I’ve tried to highlight provocative work by bloggers who may not be well-known to HealthBeat readers, as well as posts about topics that we have been discussing here. Inevitably, I have left out some excellent entries. You’ll find Fleming’s full report here http://healthaffairs.org/blog/2011/05/26/health-wonk-review-memorial-day-edition/

Alzheimer’s: Laura Newman recently spent three days “listening to expert neurologists, demographers, caregivers, and policy people talk about Alzheimer’s,” Flelming reports,  and she has a host of interesting and informed questions about all aspects of the disease and how reporters and bloggers can most usefully write about it. She details her thoughts in a post on her blog, Patient POV

Continue reading →

Yesterday the New York Times asked me to participate in a "Room for Debate" forum on Medicare reform. Here’s the topic: "The Obama administration will soon track spending on millions of individual beneficiaries, reward hospitals that hold down costs and penalize those whose patients prove most expensive. What’s the one thing Medicare should stop paying for? Please be specific."

See the full Forum, and reader’s comments here. The New York Times also ran a news story that questioned Medicare’s plans that you can access here.

Below, my contribution to “Room for Debate.”

Note: The Times headlined my piece “Don’t Let Oncologists Make All of the Decisions” which might suggest that I’m “blaming oncologists.” My original headline was the one I use below. My argument is that the burden is on the hospital: it’s up to the hospital to ensure that patients know that palliative care exists, and that a palliative care consult doesn’t mean that they are dying or that they should give up treatment. Palliative care consults are appropriate for any seriously ill patient who wants to know more about his odds and the risks and benefits of various procedures.

Continue reading →