Tuesday, December 18, 2007
Health Care Reform Distilled
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GruntDoc has an excellent distillation of the choices to be made in health care reform:
"Price.
Quality.
Access.
Pick any two"
Sort of a permutation of C. Everett Koop when he said that Americans want the best medical care in the world, they want it for free, and they want it now.
Sunday, December 16, 2007
Patients pay only 14% of health care costs? Wow.
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Free the market; Government interference hampers healthcare reform
"In a system in which medical care seems free or is artificially inexpensive, with someone else paying for one's healthcare, medical costs spiral out of control because we are encouraged to demand medical services without having to consider their real price. For every dollar's worth of hospital care a patient consumes, that patient pays only about 3 cents out of pocket; the rest is paid by third-party coverage. And for the healthcare system as a whole, patients pay only about 14%."
This article has several nice pieces of data.
Saturday, December 15, 2007
Pennsylvania's Ed Rendell Playing Games With Mcare Abatement
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The Governor of my state, Ed Rendell, has decided he wants to spend any surplus from the catastrophic malpractice insurance fund (which pays awards and settlements over $500,000) on providing insurance for uninsured adults in Pennsylvania. He wants this so much that that he's threatened not to renew the Mcare program unless he gets what he wants. Thought he State Senate has voted to extend the abatement, the House adjourned before voting.
Here's an interesting quote from Rendell:
"We're not going to go through the pain initially of having the doctors send in their checks, and then having to return them if we continue the (subsidy)," Rendell said after speaking at a nurses' conference in Hershey."
What about the pain of the physicians who will have to figure out how to get the money to pay the full amount in January rather than April? Does the Governor think it's harder for the State to issue a refund than it is for doctors to get their hands on that kinds of money?
There should be no linkage between renewal of Mcare abatement and funding of the Cover All Pennsylvanians insurance program. Mcare funds should be used to cover the program's unfunded liability and make it easier to privatize later. The Governor's Cover All Pennsylvanians should get funding in a way that does not impact Mcare's ability to retire unfunded liability and he should stop playing political games to fund it otherwise.
Tuesday, June 19, 2007
Sicko: Socialism in a capitalist society?
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This is the best summary I've read of the barriers to implementing significant change to our current health care system:
Sicko: Socialism in a capitalist society?:
"Bang the Drum with some analysis of whether a government-run health care system is possible in America:
To accomplish any meaningful reform, Americans will have to dismantle the insurance and pharma lobbies at a minimum, and begin to tackle the question of how to deliver universal health care without tying it to employment, marital status, or other qualifiers (and figure out how to put all those unemployed pharma and insurance reps to work, too). Once those lobbies have been set aside, the questions of how to implement a healthcare system which avoids the pitfalls faced by Canada, the UK and France, embraces the positives in the Cuban system, and essentially folds a socialist system into a capitalist society will have to be addressed.
"
[Via Kevin, MD - Medical Weblog]
Friday, March 30, 2007
P4P: Are Vested Interests Pushing the Agenda?
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New Data, More Doubts About Pay-for-Performance (P4P)
"Again, as we have noted before, developing performance measures that will truly benefit patients will require detailed understanding of the clinical context, keen skeptical analysis of the available relevant research data, and careful balancing of benefits, harms and costs. All this would be very hard under the best of circumstances. But the continual attempts by those with vested ideological and financial interests to influence performance measures to advance their own interests make it unlikely that the whole P4P movement will have any good effects on patients.
The first improvement needed in the P4P movement is clear, detailed disclosure of all conflicts of interest affecting those involved in the movement at any stage.
At this point, patients and physicians should be very skeptical about who is likely to benefit from any new performance measure, particularly measures that are lavishly promoted."
This nicely sums up my suspicions about P4P beyond just the fact that it rewards task completion over the exercise of medical judgement...
[Health Care Renewal]
Wednesday, February 21, 2007
DaVinci Surgical Robots. A Hospital CEO Asks Advice.
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Running a hospital: da Vinci Uncoded -- or, Surgical Robots Unite!
"Here you have it folks -- the problem facing every hospital, and especially every academic medical center. Do I spend over $1 million on a machine that has no proven incremental value for patients, so that our doctors can become adept at using it and stay up-to-date with the "state of the art", so that I can then spend more money marketing it, and so that I can protect profitable market share against similar moves by my competitors?"
I just discovered this blog today via Medgadget and am already impressed. The large health system our group works in purchased a DaVinci last year. I don't know outcomes yet but it was apparent to me before the purchase that it was largely driven by regional competition in Central Pennsylvania. I think it's telling that many of the institutions which were the early adopters no longer use the systems.
I'm hoping to pick one up cheap in a couple of years so I can do labor epidurals from home. ;-p
Monday, February 19, 2007
Is CRNA Independent Practice Coming to Pennsylvania?
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Governor Rendell's 2007 budget document includes a section titled Prescription for Pennsylvania on page A3.32. The first paragraph of that section states:
"Ensuring that all licensed health care providers – including nurses, advanced nurse practitioners, midwives, physician assistants, pharmacists and dental hygienists – can practice to the fullest extent of their training. Pennsylvania consistently lags behind other states in fully utilizing health care providers who are not physicians. Prescription for Pennsylvania will seek to eliminate the barriers in existing laws, regulations and insurance reimbursement policies that limit the ability of health care providers to practice to the fullest extent allowed by their training and education."
Sounds like independent practice to me. Rather than write a knee-jerk reaction right now, I'd like to take some time to educate myself and consider the ramifications...
Saturday, January 21, 2006
Can damage caps influence premium growth and physician supply?
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The Impact of Caps on Damages: How are Markets for Medical Liability Insurance and Medical Services Affected?
"[This report] provides a summary of research on the impact of caps including those on punitive and total damages in addition to those that apply only to non-economic damages. Our focus is on those papers that employ statistical techniques to control for potentially competing explanations of changes that are observed when simple descriptive statistics are used."
and concludes
"the body of research on the impacts of tort reform shows that caps have resulted in lower growth in medical liability losses in states that passed caps than in states that did not. The more recent literature on premium effects has found that caps result in lower premium growth. And, two very recent papers based on sufficiently many years of the AMAâs Masterfile data have found that non-economic caps and direct tort reforms more generally have a positive effect on the number of physicians per capita in a state."
Sunday, January 1, 2006
QA On New Medicare Part B Prescription Drug Plan
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Deconstructing drug plan
- Who is eligible for the new Medicare drug benefit?
- What does the basic Part D plan include?
- Do I have to enroll in a Medicare drug plan?
- Do I have to decide today?
- What if I miss the deadline?
- My drug costs are really low and I don't have any coverage. Do I really need this?
More at http://www.medicare.gov/pdphome.asp
Saturday, March 12, 2005
Consequences of Physician Report Cards
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The Medical Informatics Weblog: Consequences of Physician Report Cards:
"Reporting quality information publicly can promote quality improvement. However, according to an article in the current issue of the JAMA, the Journal of the American Medical Association, the value of publicly reporting quality information is essentially undemonstrated and may have unintended and negative consequences on health care. These unintended consequences include causing physicians to avoid sick patients in an attempt to improve their quality ranking, encouraging physicians to achieve “target rates” for health care interventions even when it may be inappropriate among some patients, and discounting patient preferences and clinical judgment."
This is a very timely JAMA article as the Pennsylvania Health Care Cost Containment Council has just published its Guide to Coronary Bypass Graft Surgery 2003 in which it assigns higher than expected adjusted mortality mortality scores to three surgeons that I feel are head and shoulders above the rest in the list. In other words, it dinged the surgeons I think are the best. (as an aside, none practice an Pennsylvania any longer)
Frist Indicates Willingness To Compromise With Democrats on Malpractice Legislation
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Kaisernetwork.org--Frist Indicates Willingness To Compromise With Democrats on Malpractice Legislation:
" Senate Majority Leader Bill Frist (R-Tenn.) on Thursday said he would again push for medical malpractice legislation this session and indicated that he would consider compromises with Democrats to examine the "elements of insurance reform" in addition to establishing caps on noneconomic damages awards, CongressDaily reports. Republicans have been unsuccessful in passing legislation that would impose a $250,000 cap on noneconomic damages because of Democratic filibusters. Democrats maintain that rising medical malpractice insurance premiums stem from problems within the insurance industry. Frist suggested that he might be willing to reconsider the $250,000 limit but added, "There absolutely should be a cap." According to Frist, medical malpractice reform will be considered in the Senate after bankruptcy and other tort reform legislation, including changes to the asbestos litigation system, are addressed (Heil, CongressDaily, 3/10). "
Senate Committee Approves Bill To Establish Medical Error Reporting Database
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Kaisernetwork.org--Capitol Hill Watch | Senate Committee Approves Bill To Establish Medical Error Reporting Database - :
" The Senate Health, Education, Labor and Pension Committee on Wednesday approved by voice vote a bill (S 544) that would create a database to allow care providers to report medical errors, CQ Today reports. The database would be used to track medical errors, examine trends and prevent reoccurring mistakes, CQ Today reports. Information included in the database would not be used in medical malpractice lawsuits, according to CQ Today. Before the full Senate considers the measure, committee Chair Michael Enzi (R-Wyo.) and Sen. Edward Kennedy (D-Mass.) are expected to insert language to clarify that the bill would not affect information already available to attorneys for use in malpractice suits. The committee last year approved similar legislation, which was unanimously approved by the Senate. The House approved a separate version of the legislation, but the issue died after conference committee members were not appointed. The new bill is expected to pass the Senate. The House Energy and Commerce Committee has not yet scheduled a review of the bill (Schuler, CQ Today, 3/9). "
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