June 26th, 2011 by Toni Brayer, M.D. in Health Policy, Opinion
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An article by Brian Klepper and Paul Fischer at Health Affairs has me all fired up. Finally these two health experts are calling it like it is. The Wall Street Journal, New York Times and EverythingHealth have written before about the way primary care is undervalued and underpayed in this country and how it is harming the health and economics of the United States.
A secretive, specialist-dominated panel within the American Medical Association called the RUC has been valuing medical services for decades. They divvy up billions of Medicare and Medicaid dollars and all insurance payers base their reimbursement on these values also. The result has been gross overpayment of procedures and medical specialists and underpayment of doctors who practice primary care in internal medicine, family medicine and pediatrics). These payment inequities have led us to a shortage of these doctors and medical costs skyrocket as a result. As Uwe E. Reinhardt says, “Surely there is something absurd when a nation pays a primary care physician poorly relative to other specialists and then wrings its hands over a shortage of primary care physicians.”
Klepper, Fischer and author Kathleen Behan make a bold suggestion. Let’s quit complaining about the RUC and their flawed methodologies. Let’s quit admiring the problem of financial conflicts of interest and the primary care labor shortage. It’s time for the primary care specialty societies, Read more »
*This blog post was originally published at ACP Internist*
June 22nd, 2011 by Happy Hospitalist in Health Policy, Opinion
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Are government entities required to pay the hospital bills of incarcerated prisoners? This is a scenario that happens quite often. Jailed patients are admitted onto the hospitalist service through the ER for anything from patients faking seizures in the ER to chest pain to drug overdoses. When patients are under the custody of the city, state or federal system, those entities are required to pay for necessary acute health care services. I don’t know, maybe it has something to do with a prisoner’s constitutional right. You lose your right to vote, but not to get a liver transplant.
So what happens? Jailed patients get admitted and guards, sometimes, one, two or three at a time, are required to be at the patient’s bedside 24 hours a day. If the patient needs to transport to the radiology department, sometimes this must be arranged with the guards ahead of time to allow extra staffing for the transport.
As you can tell, having a jailed patient is expensive, not only for the cost of the incurred hospital expenses but also the extra labor costs of having additional guards in the patient’s room 24 hours a day. So what’s a city to do? Read more »
*This blog post was originally published at The Happy Hospitalist*
June 10th, 2011 by Happy Hospitalist in Health Policy
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Hospital costs are out of control. We have an aging population living longer with more complicated presentation of disease. We have an insurance driven platform instead of a health driven accountability. The long term sustainability of that architecture is one of guaranteed insolvency.
One way or another hospitals are going to find their lifeline cut off. Medicaid is bankrupt. Hospital profit margins from Medicare have been negative for almost a decade. In addition, the rapid rise in private insurance premiums and industry’s gradual but accelerating exit from the health insurance benefit market all tell me that hospitals must find a way to reduce the cost of providing care.
There are many ways hospital costs can be reduced. Administrators are paid handsomely to make it happen. Either they do or they don’t succeed. Either they survive the coming Armageddon of hospital funding or they don’t. The hospitals least able to reduce their expenses in a market of decreasing payment will fold and other hospitals will become too big to fail. You want to be too big to fail. That’s the goal. If you can survive the coming tsunami, you will be saved and bailed out when you are the only one left standing. That is what history has taught us.
So, how can hospital costs be reduced? One way is to Read more »
*This blog post was originally published at The Happy Hospitalist*
June 9th, 2011 by Dr. Val Jones in News, Opinion
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The World Health Organization (WHO) and the World Bank just revealed the first-ever global estimate of disability. The report suggests that at least 1 billion people are currently disabled, and about 1/5 of those are experiencing significant difficulties with their activities of daily living. Since people with disabilities experience poorer health, lower educational achievements, fewer economic opportunities and higher rates of poverty than people without disabilities, this vulnerable segment of the population needs much closer attention.
I’m a physical medicine and rehabilitation (PM&R) specialist by training, and there are only about 8000 of us in the United States. Some have called PM&R specialists: “primary care physicians for the disabled” and I think that’s a reasonable description. The task before us is daunting – with hundreds of millions of people who are not living their lives at maximum functional capacity, rehab physicians should be in great demand.
My experience is that while the demand is great, funding is limited. I’ve seen tragic cases of children being denied critical wheelchair parts, and Read more »
April 30th, 2011 by DrRich in Health Policy, Opinion
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The last two weeks have made clear that the debate over our national debt will play a major role in the next election cycle.
On one side, many Republicans, lead by Representative Ryan, insist that the rate of growth of our national debt – especially the massive projected growth of Medicare and Medicaid – promises to destroy our society within a generation or two; and that the only way to avert that catastrophe is to make substantial structural changes to our entitlement programs. The subtext of their message is: Federal debt is bad, and debt of this magnitude will be fatal.
On the other side, most Democrats, led by President Obama, stress that our entitlement programs are promises that simply can’t be changed in any substantial way, insist that such entitlements are “investments in our future,” and suggest that whatever shortfalls our current system might encounter can be remedied by taxing millionaires and billionaires. The subtext of their message is: Federal debt can be a force for good, and in this case will trigger a much-needed redistribution of wealth (which is a primary goal of Progressives).
The debate over the national debt is as old as the Republic. In the original version of this debate, the part of the modern Republicans (i.e., debt is bad) was played by Jefferson, and the part of modern Democrats (i.e., debt is an investment in the future) by Hamilton. Read more »
*This blog post was originally published at The Covert Rationing Blog*
