May 1st, 2011 by Shadowfax in Health Policy, Opinion
Tags: Containing Costs, Critical Care, Death, Emergency Medicine, End Of Life Care, Futile Care, Healthcare Costs, Hospice, ICU, Medicare, When Will You Die?
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One interesting comment I have seen come up over and over is the idea that end-of-life costs are the thing that is spiralling out of control and that if we could somehow find a way to curb the costs of futile care, then that would somehow solve the health care inflation crisis. Andrew Sullivan endorsed such an idea the other day, a “Modest Proposal,” which is not nearly as radical or amusing as Swift’s. And indeed, there is a modicum of sense in the idea.
Estimates are that spending in the last six months of a person’s life account for 30-50% of their overall health care costs, and that the spending in the last year of a person’s life accounts for 25% of overall medicare spending. So — simple solution, right? cut down on the futile care, and we’re good to go.
Only problem — as a doctor, I sometimes have a hard time telling when someone is in their last DAY of life, let alone last year. Read more »
*This blog post was originally published at Movin' Meat*
May 1st, 2011 by John Di Saia, M.D. in News, Opinion
Tags: Business, California, Cosmetic Medicine, Cosmetic Surgery, Medicine, Physician-Owned Hospitals, Plastic Surgery
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This MSN article states that doctor-owned hospitals are on the rise. In California, the opposite is the case. The hospital business is a lousy business in which to be. I would rather open a surgical facility. I had an opportunity to be a part of a group that bought a hospital a few years ago and passed.
In California, real medicine is going into the toilet as doctors realize that the work they have put in to get educated makes practicing fairly unrewarding. Niche markets and gimmicks are replacing the conventional medical landscape. That’s the reason we have so many non-plastic surgeons turning to cosmetic work. The bottom line is that you need to pay doctors enough so they can make a decent living or they will find something else to do.
Sad but true.
*This blog post was originally published at Truth in Cosmetic Surgery*
May 1st, 2011 by admin in Opinion
Tags: Breast Cancer, Cure, Double Mastectomies, Genomics, Guidelines, Mammograms, Oncology, Peace Of Mind, Prevention, Prostate Cancer, Psychiatry, Screenings, Watchful Waiting
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The rise of prophylactic double mastectomy in women with increased risk of breast cancer has been a topic of recent discussion. In particular, this trend has been observed amongst women with the diagnosis of unilateral carcinoma in situ, or pre-invasive breast cancer. While it has been known that in women with genetic cancer syndromes, including BRCA1 and BRCA2, double mastectomy reduces risk, the efficacy of the approach is uncertain in women with other risk profiles, yet more women and surgeons seem to be doing it.
Knowing when to test, treat and act is part of art of medical practice. The ability to convey this information effectively is also an art. Both patients and doctors may have a hard time embracing watchful waiting with respect to many forms of cancer and pre-cancer. In the case of cancer of the cervix, it is known that infection with human papillomavirus (HPV) is causative in cancer development. However, only a small percentage of those infected actually go on to get cancer. Low grade dysplasia, a condition that is early in the cervical cancer development continuum, frequently spontaneously resolves without treatment. Fortunately, in the case of cervical cancer, there is now a vaccine to prevent high risk HPV infection.
“Watchful waiting” has been most discussed as a treatment strategy for prostate cancer. Read more »
*This blog post was originally published at ACP Internist*
April 30th, 2011 by StevenWilkinsMPH in Health Policy, Opinion
Tags: Accountable Care Organizations, Depression, Doctor-Patient Communication, Employer, Healthcare Costs, Mental Health, Obesity, Patient-Centered Medical Home, Primary Care, Psychiatry, Psychology, Uncategorized, Value
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Ok…here’s a brain teaser. What medical condition is the most costly to employers? I’ll give you a hint. It is also a medical condition that is likely to go unrecognized and undiagnosed by primary care physicians.
If you guessed depression you are correct. If you mentioned obesity you get a gold star since that comes in right behind depression for both criteria…at least in terms of cost and the undiagnosed part.
Four out of every ten people at work or sitting in the doctor’s waiting room suffer from moderate to severe depression. Prevalence rates for depression are highest among women and older patients with chronic conditions. Yet despite its high prevalence and costly nature, depression is significantly under-diagnosed (<50%) and under-treated by physicians.
For employers, the cost of depression cost far exceeds the direct costs associated with its diagnosis and treatment As the graphic above indicates, the cost of lost productivity for on the job depressed workers (Presenteeism) and lost time for depressed workers that are absent from the job (Absenteeism) far exceed the cost of cost of treatment (medical and medication cost).
Read more »
*This blog post was originally published at Mind The Gap*
April 30th, 2011 by DrRich in Health Policy, Opinion
Tags: Bad Debt, CMS, Democrats, Entitlements, Federal Debt, Good Debt, Hamilton, Jefferson, medicaid, Medicare, Obamacare, Republicans
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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*
