February 15th, 2009 by Dr. Val Jones in Health Policy, Humor, True Stories
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Every once in a while I like to embarrass my husband on my blog, not just because it’s the sweetest form of revenge, but because this is a blog after all – and it’s supposed to drift into the personal realm occasionally, just to keep it interesting.
Tonight’s pre-dinner conversation was classic. I thought I’d share it with you all…
Husband: Should I make rice to go along with the salmon?
Dr. Val: No, white rice is boring. Let’s try something more interesting. Like quinoa. We have some in the pantry.
Husband: I don’t like quinoa.
Dr. Val: Why not? It’s delicious.
Husband: No it’s not. It doesn’t taste right.
Dr. Val: What do you mean? What do you think it tastes like?
Husband: It tastes like…
Dr. Val: Like???
Husband: Like something I don’t want to eat.
February 15th, 2009 by Dr. Val Jones in Health Policy
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There is no doubt in anyone’s mind that the U.S. healthcare system, in its current form, is financially unsustainable. Many in Washington believe that 2009 will usher in more sweeping reform than we’ve seen in decades. I attended the Medicare Policy Summit (along with about 100+ industry insiders and one other physician, Dr. Nancy Nielsen) to try to read the “tea leaves” regarding Medicare’s likely reform – and how that will impact the healthcare system in general.
I took 49 pages of notes during the two-day conference, but will spare you the gory details and simply capture (in a series of blog posts) what I found to be the most interesting parts of the discussion. This post is devoted to highlights from Bruce Vavricheck’s lecture, “The President’s Budget and What It Means for Entitlements.”
Bruce Varvichek is the Assistant Director for Health and Human Resources, Congressional Budget Office.
Bruce explained that if we continue on our current healthcare spending path, over 50% of all federal spending will go towards funding Medicare, Medicaid, and Social Security entitlement programs by 2018.
What are the underlying causes for this rapid rate of growth in spending?
1. Chronic Illness. The sickest, top 5% of Medicare beneficiaries account for 43% of all Medicare spending. Cost containment should focus on identifying these 5% early, and intervening so as to prevent advancement of disease where possible. Solution: The “medical home” model may help to identify people who are likely to become sick, and engage them in preventive health programs early.
2. Obesity. Rises in obesity rates is directly related to increased heart disease, diabetes, cancer, and other chronic disease prevalence. The fastest growing segment of the population that is becoming obese is the high income bracket. Bruce concludes: “This can’t just be explained by McDonald’s.”
3. Non outcomes-based spending. Medicare beneficiaries with the same medical conditions receive widely different medical services depending on where they are in the country. More services, however, do not correlate with improved outcomes.
Solution: Comparative Effectiveness Research
What changes in Medicare benefits is the Congressional Budget Office considering?
1. Creating Medicare insurance buy-in for people ages 62-64.
2. Reduce or eliminate 24 month waiting period for disabled people to become eligible for Medicare.
3. Increase the age of eligibility of Medicare beneficiaries to 67. This encourages people to work longer since average lifespan has been steadily increasing.
CBO Strategies to improve quality and efficiency of care:
1. Bundle Medicare payments so that hospital and post-acute care are linked. This will incentivize hospitals to do a better job of follow up once patients are discharged from the hospital.
2. Reduce payments (after risk-adjustment) to hospitals with higher re-admission rates.
3. Offer physicians performance-based payments for managing and coordinating care for their patients (the medical home model).
4. Create incentives and penalties to promote adoption and use of HIT.
CBO strategies to streamline payment structure and benefits:
1. Modify the Sustainable Growth Rate (SGR) formula used to determine payments to physicians. Put a cap on total spending.
2. Change Medicare Advantage program to fee for service.
3. Replace the current beneficiary cost-sharing structure with a unified deductible and uniform cost-sharing plan. Add catastrophic limit for out-of-pocket spending.
4. Require drug manufacturers to pay a rebate to Medicare for drugs covered in Part D.
5. Fill in the “donut hole” in Part D.
***
Next up: Grace Marie Turner and the free market gang debate the merits of a government-run healthcare system.
February 12th, 2009 by Dr. Val Jones in Expert Interviews, Health Policy
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I attended my very first Medicare Policy Summit conference today – and it was truly riveting (wonk alert). I took copious notes and will do my best to summarize some key points in a series of blog posts. This first post is devoted to the presentation by AMA President, Dr. Nancy Nielsen.
Dr. Nielsen began her lecture with an amusing story. She said, “congressional hearings are pure theatre” and described what she’d experienced three months ago at a meeting with Pete Stark. The conversation went something like this:
Stark: I’m sick of rich doctors driving up in their Porsches saying ‘I’m pulling out of Medicare.’
Nielsen: [Thinking to herself: First witness please?] I drive a GEO jeep.
Then Dr. Nielsen looked out at the Medicare Policy Summit audience and asked, “are there any doctors here?” I raised my hand enthusiastically at the back of the room. Then she responded, “Oh thank God. Well, you know we’re in the lion’s den…”
[Parenthetically, I didn’t see anyone else raise their hand – which is the subject for another conversation.]
What Is The AMA’s Current Agenda?
1. To expand coverage for the uninsured
2. To reform the physician payment system
3. To improve the quality and safety of healthcare
4. To improve public health
What Is The Bee In Nielsen’s Bonnet?
Nielsen explained that the sustainable growth rate is unsustainable. She stated:
“We can’t go through the annual death dance with congress over this. There is another 21% across-the-board cut in Medicare reimbursement scheduled for January 2010. And this cut will affect a group of small business owners (aka physicians) whose reimbursement has not increased since 2001 while their costs have increased 20%.”
What Does Nielsen Propose We Do?
1. Reform the system so that it reimburses for care coordination and prevention
2. Craft solutions based around patients’ needs
3. Rebase the SGR
4. Bundle services to increase value and reduce costs
5. Invest in disease prevention and wellness
6. Use comparative effectiveness to inform clinical decision-making (but NOT as a basis for coverage decisions)
7. Bring physicians into the policy decision-making process
Closing High-Five to Nurses
Dr. Nielsen closed with an amusing anecdote about inauguration day. Apparently she was standing in the sidelines of the parade route where Biden got out of his limo to greet the crowd. He gave a big hug to some nurses standing next to her and said, “I love nurses. They’re so much better than doctors.” Dr. Nielsen then had the opportunity to introduce herself to Biden and he responded, “Doctors saved my life, but nurses gave me the will to live.”
February 12th, 2009 by Stacy Stryer, M.D. in Opinion
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By Stacy Beller Stryer, M.D.
I attended a school meeting last night – the second in two nights for my daughters, who are entering middle school and high school, respectively. My younger daughter will be entering a magnet school, while my older daughter, who is graduating in June from the same magnet school, will be starting an accelerated program within her local high school. Let me add that we live in one of the most rigorous, high-achieving counties in the United States. I am excited for both of them and, obviously, academics are stressed within our family. I want them to be excited by their studies and to push themselves to succeed.
Yet I worry about the stress that surrounds this type of environment – stress which is initiated by all – teachers, parents and the students themselves. The meeting last night included a panel of students in the accelerated high school program, each discussing various aspects of their academic and extracurricular lives. What struck me most were two things. First of all, by the time they graduate, these students will have taken an average of almost 10 AP (advanced placement) classes – classes where they can take a test to get college credit. Last year, two students had taken 13 AP classes in high school. The majority of the classes they took which were not AP were either honors classes or courses which were accelerated in some other way. The second thing that struck me was the sheer number of extracurricular activities some participated in on top of their academic schedule. When did they have time to eat or sleep? When I asked them how many hours they slept each night, the program director quickly brushed off my question and moved on to the next.
Stress in teens has become a great concern in society today, particularly for girls who not only want to succeed academically, but also in sports, social settings, and with regards to their physical appearance. These days many teens are not satisfied with just doing a good job, but they want to do the best job. So if somebody is taking 9 AP classes, they want to take 10. They don’t just want to be on the tennis team, but they want to be the captain of the team.
Stress takes its toll on teens. It increases irritability, anger, moodiness, feelings of hopelessness, inability to concentrate and sleep. It also increases physical complaints, such as stomachaches and headaches. Lack of sleep causes similar problems, plus decreased school and motor performance. It can also lead to school resentment, school burnout, and experimentation with alcohol or drugs to cope with the stress.
How do we stop this steep incline? We certainly want our children to succeed, and I am no different from the next parent. We are proud of our children when they have drive and ambition – and when they do well. After all, these are characteristics which are important and helpful in becoming successful adults. Yet, as adults, both parents and teachers need to know when to put on the brakes and slow our kids down. We need to find out how stressed our kids really feel, how much they actually sleep, and whether they are able to find time to relax for awhile each week. Perhaps we can encourage our children to take an elective rather than that 11th AP course, or to go out with their friends on a Saturday rather than spend the entire weekend studying. We don’t only want our kids to be successful, but we also want them to be happy. Don’t we?
