As regular HealthBeat readers know, I’ve been writing about the risks of PSA testing for early-stage prostate cancer since I launched this blog in 2007. 

The American Cancer Society does not support routine PSA testing for prostate cancer. Testing often leads to unnecessary treatment which, in turn, leads to life-changing side effects—namely incontinence and impotence. Moreover, early detection does not guarantee a cure. See these posts on HeathBeat: here and here. Finally, see this very informative NYT story that I posted about in 2008.

Nevertheless, The New York Daily News has once again launched a campaign urging men to take advantage of FREE PSA testing. (Of course the treatment that follows won’t be free, but that’s another story.)

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Summary: Opponents of reform will continue to pretend that at some point in the future, “Obama-care” will mean drastic across-the-board cuts in reimbursements to doctors who take Medicare patients, forcing many to abandon their patients. The Senate’s bi-partisan action on Friday should serve as a reminder that this just isn’t true. Congress never has and never will implement the blind cuts that the SGR formula calls for. The SGR has nothing to do with the reform legislation President Obama signed in March. In fact, the Affordable Care Act hikes payments to many physicians.

 Friday, June 18, the Senate aproved a plan that blocks a 21 percent cut in Medicare payments to physicians; the axe was scheduled to fall that day. Leadership on both sides of the aisle pushed for the reprieve; it will remain in place for six months. The measure will now need to be considered by the House, which in May approved a fix that would last longer. If the House agrees that the cut should not be implemented–and it is all but certain that it will–the 21 percent cut wil be replaced with a 2.2 percent pay hike. The bill will not add to the deficit. The proposal is fully offset by changes in Medicare billing regulations, antifraud provisions and the tightening of some pension rules, eliminating Republican objections that it would push the federal government deeper into debt. The only question is whether the House will demand a full repeal of the SGR formula which calls for a 21 percent cut, or at least, a much longer repreive.

In six months, Congress will have to consider the matter once again, just as it has ever year since 2003.  This is the third time this year that Congress has averted Draconian cuts to physician’s payments. What, you might wonder, is going on?  Here is the back-story:  in 1997, Congress enacted a so-called "sustainable growth rate" (SGR) mechanism to keep Medicare physician reimbursement rates in check. Congress has never allowed the full cuts called for under the SGR formula to take effect and it never will.

Why don’t legislators simply repeal the cuts to doctors’ fees that they have been postponing for years?  Why just put off the measure for another six months? 

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Summary:  Deficit Hawks want to slash both Medicare and Social Security, and they seem to be in control of the President’s National Commission on Fiscal Responsibility and Reform. Hovering in the wings, aging mogul Pete Peterson is eager to help them do the job.

The irony is that cutting domestic spending is exactly what we shouldn’t do in the midst of this economic crisis. As George Soros explains, when you’re skidding you have to turn into the skid.

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Both liberals and conservative critics have charged that the health reform legislation that President Obama signed this spring focuses mainly on insurance coverage, and does little to rein in the spiraling cost of health care. This isn’t true. But the legislation is dense– and, as usual, the truth is more complicated than a lie. There is no single “fix” that will “break the curve” of health care inflation. The Affordable Care Act (ACA) contains multiple provisions that open the door to cost containment in myriad ways.

 In today’s issue of The New England Journal of Medicine (NEJM), Peter Orszag, director of the White House Office of Management and Budget (OMB) and OMB special health advisor Zeke Emmanuel explain how the bill will make Medicare more affordable:   “Perhaps most fundamentally,” they write, “the ACA recognizes that reform, particularly changing the delivery system, is not a one-time event. It is an ongoing, evolutionary process requiring continuous adjustment. The ACA therefore establishes a number of institutions that can respond in a flexible and dynamic way to changes in the health care system.”

What is most exciting is that under the new legislation, Congressional lobbyists will not be able to block the process: “The secretary of health and human services (HHS) is empowered to expand successful pilot programs without the need for additional legislation.”

Below excerpts from their “Perspective” in the June 16 NEJM:

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Last week, the New York Times asked me to write an opinion piece for its “Room for Debate” section.

Here is the topic that the Times asked participants to discuss:

“An article in the Times this week focuses on a 5,000-member clan in Colombia that has an unusually high incidence of early-onset Alzheimer’s disease. A medical study of this large family, which lives in one Andes region, is being planned to see if giving treatment before dementia starts can lead to preventing the disease. In that traditional society, the heavy burden of caring for the ill falls on siblings, spouses, children and other family members.

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Children have become the new growth industry for
prescription drug makers. A study released last month by the pharmacy benefit
manager Medco found that 26% of kids under 19—almost
30% of those aged 10 to 19—are now taking prescription medications for a
chronic condition. Meanwhile, spending on prescription drugs for children
increased by almost 11% last year, the largest increase experienced by all
segments of the market, including the elderly. Although asthma drugs are the
still the most commonly prescribed therapeutics, kids are increasingly being
prescribed drugs that are decidedly uncommon for such young patients: atypical
anti-psychotics, diabetes drugs, anti-hypertensives, cholesterol medications
and heartburn drugs—expensive therapeutics that in the past were rarely used
outside of adult populations.

The Medco figures are alarming first of all because
intuitively it just feels wrong that so many children are downing prescription
pills along with their morning multivitamin and orange juice. Kids are supposed
to be healthy, full of energy, free spirited. But increasingly, this is not the
case. More than 17% of adolescents (10-19 year olds) are now classified as
obese: in fact, a whopping one out of three kids is considered overweight or
obese. And obesity brings with it a raft of formerly adult chronic
conditions.  According to a fact
sheet provided by the Institute of Medicine, in one population-based sample some 60% of obese children aged 5 to 10 years
had at least one cardiovascular disease risk factor—including high levels of
total cholesterol, triglycerides, insulin, or high blood pressure—and 25
percent had two or more of these risk factors.

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When Lewis Blackman, a healthy, gifted 15-year-old, underwent elective surgery at the Medical University of South Carolina– one of the state's most modern hospitals–he was in good health. Over the next four days, he bled to death.
 

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Lewis Blackman’s mother, Helen Haskell, founder of Mothers against Medical Error, sent me this article, first published in The State (Columbia, South Carolina). Her story serves as an extreme example of the dangers that hospital patients can encounter when residents are working without more experienced doctors supervising them. I’m posting the story and commenting on it  [in brackets] because too often, patients suffer when residents are working without a net.

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Yesterday, I commented on a New York Times story that appeared Wednesday, June 2, attacking the Dartmouth Research.  The work that Dartmouth has done over the past two decades suggests that hospitals in some parts of the country are over-treating patients. Overtreatment means that patients who didn’t need to be in the hospital in the first place are exposed to the side effects of treatment as well as gruesome hospital- acquired infections, medication mix-ups and a host of other medical errors. Thus unnecessary care puts patients at risk while helping to drive health care bills heavenward— and suggests that we could rein in Medicare spending by squeezing some of that hazardous waste out of the system.  But according to the Times: “Data [from Dartmouth] Used to Justify Health Savings Effort is Sometimes Shaky.”

In Part 1 of this post I discussed what two of the Times’ sources told me about how the Times’ reporters misrepresented what they said. Both Harvard economist David Cutler and Yale’s Dr. Harlan M. Krumholz complained that the story made it seem that they are critics of the research, when in fact they agree with Dartmouth on the basic message of the data, and see the work as, in Krumholz’ words “pivotal to moving us forward  . . . we all agree that there is lots of waste and it is unevenly distributed across the country.”

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Today, the New York Times published a piece about the Dartmouth research that is raising eyebrows– in part because there are so many factual mistakes in the story, in part because the tone is so personal.

“It sounds as if it were written by someone’s ex-spouse,” a source who is very familiar with Dartmouth’s work told me in a phone conversation earlier today.

“Harris and Abelson were determined to write a story that would ‘take down Dartmouth,’”  confides a second source in Washington who spoke with the Times reporters.

This is the second critical piece that Times’ reporter Gardiner
Harris has written about Dartmouth’s highly-respected work in just four
months. I wrote about the first story here
noting  that the article “garbled the facts” about the research, and
quoted Dr. Elliott Fisher, the senior researcher, out of context.

Others quoted in today’s story indicate that the Times’ piece distorted what they said:
“Every word is clearly accurate, but the implication is wrong,” says
David Cutler, a Harvard economist health care policy expert who has
advised President Obama on healthcare.

Dr. Harlan M. Krumholz, a professor of medicine and health policy
expert at Yale also was quoted as if he doubted the basic thrust of
Dartmouth’s work. The Times’ reporters  used  just one line 
from his interview:  “It may be that some places that are spending more
are actually getting better results.”

Today, Krumholz explained:
“What I spent most of the interview trying to convey is that a lot of
the back and forth [about bits and pieces of Dartmouth’s data ] is
inside baseball stuff – and we are all working hard to figure out how
to gauge costs and value better . But Dartmouth’s work on variation is
pivotal to moving us forward – and we all agree that there is lots of
waste and it is unevenly distributed across the country.

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