March 23rd, 2010 by Richard Cooper, M.D. in Better Health Network, Health Policy, News, Opinion
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The final House “Manager’s Amendment to Reconcilliation“ provides $400M for hospitals located in counties in the lowest quartile of Medicare spending, adjusted for age, sex and race — but not income. Coupled with annual cuts of $10B in DSH and $1.5B for re-admissions, this is bad news for the poor and the hospitals that care for them. Mayo Clinic wins!
Note that adjustments cannot be based on counties. Urban counties are too big and economically varied. When the extremes of wealth and poverty are averaged, mean household income is 128% of average in Washington DC, 113% in LA, and 108% in Chicago (Cook County), all with dense and costly poverty ghettos. Without any poverty, mean household income in Olmsted County (home to Mayo Clinic) is the same as in LA. Very few truly poor counties will qualify for such payments. This is another example of the truism that “Poverty is the Problem; Wealth is the Solution.”
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
February 28th, 2010 by Richard Cooper, M.D. in Better Health Network, Opinion
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An important article appeared in the NYT recently, describing a new paper by Peter Bach, which is in today’s NEJM. Peter’s paper (“A Map to Bad Policy“) debunks the Dartmouth Atlas and cautions against its use. As I said in the Wash Post in September, the Dartmouth Atlas is the ”Wrong Map for Health Care Reform.”
More damning even than Peter’s analysis was Elliott Fisher’s reply: “Dr. Fisher agreed that the current Atlas measures should not be used to set hospital payment rates, and that looking at the care of patients at the end of life provides only limited insight into the quality of care provided to those patients. He said he and his colleagues should not be held responsible for the misinterpretation of their data.” Really? It was someone else’s interpretation? OK, Elliott, you’re not responsible. Just stand in the corner. Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
February 9th, 2010 by Richard Cooper, M.D. in Better Health Network, Health Policy, Opinion
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Commenting on the President’s budget, an editorial in the Times on Feb 2nd juxtaposed three of our nation’s dilemmas: the deficit, jobs and health care.
“President Obama got his priorities mostly right. The deficit, compared with what it could have been, is $120B. That’s a lot of money. But it’s not too much at a time of economic weakness, when deficit spending is needed to put Americans back to work.”
“Medicare and Medicaid will cost $788B; that should be another reminder of why the country needs health care reform.” Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
January 11th, 2010 by Richard Cooper, M.D. in Better Health Network, Health Policy
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The favorite sound bite of Dartmouth disciples is to compare some high cost locale with a low cost locale. First it was Miami vs. Mayo, then Birmingham vs. Grand Junction, then Los Angeles vs. Green Bay and now it’s Los Angeles vs. Portland. This time, Tom Brokaw delivered the message on Meet the Press: “At UCLA Medical Center, they spend $92,000 on the last two years of a life, but in Portland, Oregon, just north of there (it’s actually 825 miles north of there), they spend $52,000 because they’ve got better controls on Medicare. So until you begin to pay for value and pay for performance, health care reform is not going to work.”
What do Miami, Birmingham and Los Angeles have in common, and what do Rochester MN (home of Mayo), Grand Junction CO, Green Bay WI and Portland OR have in common. One thing is poverty. The maps below show the density of poverty in each (light green shows census tracks with 20-40% poverty and red shows tracks with >40% poverty). Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
December 27th, 2009 by Richard Cooper, M.D. in Better Health Network, Health Policy, Opinion
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Provisions in the Senate and House health care reform bills propose to reallocate resources based on geographic differences in Medicare spending. While well intended, they will penalize providers who care for the poor and impair access for these vulnerable patients.
A reallocation of resources to lower-cost states has been endorsed by members of Congress from states with lower Medicare spending who believe that, by receiving less from Medicare, their states are currently being penalized for being “efficient.” However, it is not efficiency that accounts for their lower spending. It is less poverty and better health status. Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
