November 8th, 2010 by Stanley Feld, M.D. in Better Health Network, Health Policy, News, Opinion
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Accountable Care Organization(ACOs) are not going to decrease the waste in the healthcare system. Waste occurs because of:
1. Excessive administrative service expenses by the healthcare insurance industry which provides administrative services for private insurance and Medicare and Medicaid. A committee is writing the final regulations covering Medical Loss ratios for President Obama’s healthcare reform act. The preliminary regulations are far from curative
2. A lack of patient responsibility in preventing the onset of chronic disease. The obesity epidemic is an example.
3. A lack of patient education in preventing the onset of complications of chronic diseases. Effective systems of chronic disease self- management must be developed.
4. The use of defensive medicine resulting in overtesting. Defensive medicine can be reduced by effective malpractice reform.
A system of incentives for patients and physicians must be developed to solve these causes of waste. A system of payments must also be developed to marginalize the excessive waste by the healthcare insurance industry. Patients must have control of their own healthcare dollars.
By developing ACOs, President Obama is increasing the complexity of the healthcare system. It will result in commoditizing medical care, provide incentives for rationing medical care, decrease access to care, and opening up avenues for future abuse.
The list of barriers to ACOs’ success is long and difficult to follow. Read more »
*This blog post was originally published at Repairing the Healthcare System*
October 31st, 2010 by Stanley Feld, M.D. in Better Health Network, Opinion
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To: Bud Selig, Commissioner of Baseball
Dear Mr. Selig:
The World Series is an exciting time. It’s important to promote the national pastime. Kids play baseball all over the world. I have been particularly interested in the post-season games this season because my home team, the Texas Rangers, is in the World Series. They have been playing magnificent baseball.
I have been both a Yankees and Rangers fan ever since the Rangers came to Texas. In fact, my brother and I went to the first Rangers game in Arlington Stadium. I have been a student of baseball strategy for many years. Baseball is a fantastic game.
Baseball players are role models to kids all over the world. A baseball player’s behavior on the playing field should be exemplary. Baseball players have been poor role models as far as spitting and scratching their crotch. I have never become immune to these tasteless rituals. Read more »
*This blog post was originally published at Repairing the Healthcare System*
October 21st, 2010 by Stanley Feld, M.D. in Better Health Network, Health Policy, News, Opinion, Research
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It is important to listen to what physicians are saying. An article appeared in SERMO, a physicians’ social network, which expressed a physician’s frustration. It is appropriate to publish some of that physician’s thoughts:
“I first heard this statement over twenty years ago, when I was an intern in general surgery, struggling to find my professional self.”
“My chief resident said; “The patient owns the disease,” “You’re not trying to make them suffer, you’re trying to help. They’re sick, you’re not.”
“The human body is unpredictable. Disease complications happen.”
The author thought his chief resident was heartless and callous. In a way, he was but he was getting at the heart of the matter. What is the patient’s responsibility in the evolution of disease? Read more »
*This blog post was originally published at Repairing the Healthcare System*
September 27th, 2010 by Stanley Feld, M.D. in Better Health Network, Health Policy, News, Opinion
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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*
June 7th, 2010 by Stanley Feld, M.D. in Better Health Network, Health Policy, Opinion, Research
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Last week I heard a lecture about Accountable Care Organizations by a physician leader working for one of the major hospital systems. His discussion made me realize that large physician organizations and hospitals are spending lots of time solving problems of quality medical care. In my opinion quality medical care has not been adequately defined.
A working definition right now is to decrease hospital stays, efficient medical care for a disease at lower cost, avoidance of medical errors in the hospital, and avoidance of hospital acquired infections. These are important goals. They must be attached to monetary incentives. Many of these problems can be solved now.
The solution demands the development of processes of care. An important question is how much money will process improvement save? I estimate that this process improvement could save an estimated 7 to 10% of the healthcare dollar.
The real question should be focused on how to repair the healthcare system by decreasing costs while improving the health of Americans. Read more »
*This blog post was originally published at Repairing the Healthcare System*
