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The Medicare Reform Act: Smoke And Mirrors For Patients And Physicians

An interesting debate occurred in the Washington Post between Michael Leavitt, former secretary of Health and Human Services and a member of the Medicare Board of Trustees from 2005 to 2009, and Dr. Don Berwick, the director of CMS.

Michael Leavitt wrote a scathing article criticizing President Obama’s Medicare Reform Act calling it an illusion. Don Berwick wrote a rebuttal to Michael Leavitt’s article.

Michael Leavitt starts off his article by stating: “Despite the report from Medicare’s trustees this month that the hospital insurance trust fund will not be depleted until 2029, 12 years later than was predicted just last year, Medicare is no better off than it was a year ago. “

The Medicare Trustees Report was strange. Nothing was done to change anything and all of a sudden, the hospital insurance fund was extended 12 years. I thought it was funny arithmetic.

Medicare Trustees is supposed to be an organization independent of the administration. Shortly afterward, Richard Foster, Chief Actuary for Medicare, who is independent of both the Medicare Trustees and the administration, wrote an “Alternative Report.” His report received little coverage in the traditional media. Read more »

*This blog post was originally published at Repairing the Healthcare System*

Should “Old Age” Be A Cause Of Death?

The Washington Post asks whether “old age” should be reconsidered as a legitimate cause of death for the elderly. Because more people are dying at very advanced ages with multiple system failure, it’s often harder for physicians to pinpoint the specific underlying cause, but using “old age” as a catch-all term could make mortality data less meaningful, the article said.

An upcoming revision of the International Classification of Diseases might provide some guidance: “Each revision of the ICD is the right moment to reconsider this question,” the co-head of the ICD’s mortality statistics committee told the Post. (Washington Post)

*This blog post was originally published at ACP Internist*

Charitable Hospitals Being Sold To For-Profits To Survive

More than one-fifth of hospitals are government-owned, but states and counties are out of cash to keep them open. So, charitable hospitals are being sold to for-profit groups or facing closures. Rising costs and more uninsured patients run smack into falling Medicare and Medicaid reimbursement. When bonds come due, there’s little chance of states and counties paying them back. And the facilities are often standalones, and they can’t fall back on corporate backing. This year, 53 hospitals have been sold in 25 arrangements. While the deals often stipulate that care for the poor continues, no one is certain exactly how or even whether such services will continue.

That said, other charitable hospitals are making big profits. What are they doing differently? First, they’re competing for patients, so they’re increasing room sizes, offering amenities and even investing in high-end procedures such as robotic surgery. They continue to offer community care, but they’re acting more like for-profit institutions to cover their charitable missions. But this conflicts with an old-fashioned view of what charitable care is supposed to be.

Stepping into the breach is the Centers for Medicare and Medicaid Services, which is offering one solution, by increasing reimbursement for inpatient services in rural areas. The agency is expanding a pilot program by increasing reimbursement for inpatient services. Facilities are eligible if they offer care to rural areas in the 20 states with the lowest population densities, have fewer than 51 beds, provide emergency-care services and are not a critical-access hospital. (Wall Street Journal, Washington Post, Modern Healthcare)

*This blog post was originally published at ACP Internist*

Patient Tests, EHRs, And Medical Homes: The Price Isn’t Right

Healthcare reform is forcing medical students to learn about the financial costs of the tests they order, as well as their clinical importance. Once a taboo topic, it’s being openly taught to students to prepare them for practice.

At Harvard, one physician in training duplicated television’s “The Price is Right” to keep his peers guessing at the costs of tests on a patient’s bill. Molly Cooke, FACP, a Regent of the College, encourages doctors to consider the value of the tests they order as they deliver care. (Kaiser Health News, New England Journal of Medicine)

The price isn’t right for electronic medical records. Even $44,000 in stimulus money isn’t enough to make doctors jump into using computers. Read more »

*This blog post was originally published at ACP Internist*

Breast Cancer Prevention: Komen And KFC?

Pink BucketsI must say I was surprised (astounded) when I first saw the KFC commercial touting their Buckets for the Cure. It’s a partnership between KFC and Susan G. Komen for the Cure. KFC donated 50 cents for each bucket purchased.

This, after the recent addition to KFC’s menu of the Double Down Sandwich! It’s my opinion that KFC doesn’t have anyone’s health as their goal.

I want to encourage anyone who wants to support Susan G. Komen for the Cure or other breast cancer groups to simply bypass KFC and donate directly to the group. Read more »

*This blog post was originally published at Suture for a Living*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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