October 18th, 2010 by BobDoherty in Better Health Network, Health Policy, News, Opinion, Research
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From its inception, Medicare has been agnostic about the effectiveness of different treatments when it sets payment rates. Once a treatment is found to be “reasonable and necessary,” Medicare establishes a payment rate that takes into account complexity and other “inputs” that go into delivering the service. But it is prohibited by law from varying payments based on how well an intervention works.
This would change under a “dynamic pricing” approach proposed by two experts in this month’s issue of Health Affairs. The article itself is available only to Health Affairs subscribers, but the Wall Street Journal health blog has a good summary.
The researchers propose that Medicare pay more for therapies with “superior” results and the same for two therapies with comparable effectiveness. A new service without any evidence on its relative effectiveness would be reimbursed in the usual way for the first three years, during which research would be conducted on its comparative effectiveness. If such research found that the service was less effective than other interventions, Medicare would have the authority to reduce payments. If it was found to be more effective, Medicare could pay more than for other available interventions. The WSJ blog gives an example of how this would work. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
October 17th, 2010 by Peter Lipson, M.D. in Better Health Network, Health Tips, Opinion, Quackery Exposed, Research
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If you google “low testosterone” you’ll see lots of ads for testosterone replacement. Some are from pharmaceutical companies that sell testosterone, others from obvious snake-oil salesmen.
Both types of ads list vague sets of symptoms, encourage you to believe that they are pathologic, and want to sell you something to make you better. For example, the pharmaceutical company Solvay gives you a handy guide for speaking to your doctor, and a quiz to see if you have “low T.” The quiz asks some questions that may be useful, but also asks very general questions about your sense of well being. Read more »
*This blog post was originally published at Science-Based Medicine*
October 17th, 2010 by Dinah Miller, M.D. in Better Health Network, Book Reviews, Opinion, True Stories
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I just finished reading Dr. Gary Small’s book, The Naked Lady Who Stood On Her Head.
In the final chapter of the book, Dr. Small talks about his mentor, friend, and father figure who’s mentioned throughout the book. The mentor approaches him on the golf course, where they meet to talk, and says he needs psychotherapy and Small is the man to do it. The author is surprised, hesitant, and a bit uncomfortable with the demand (it comes as more than a request.) His wife likens it to the need for a plumber or a dentist, and Dr. Small takes on the task. The mentor calls all the shots: Where the meetings will be, what pastry they will eat, the form of his payment. The author initially misses the diagnosis and uses this as an example of how one can be blinded.
So is it okay for a friend to treat a friend? Read more »
*This blog post was originally published at Shrink Rap*
October 17th, 2010 by Peggy Polaneczky, M.D. in Better Health Network, Health Policy, Humor, News, Opinion, True Stories
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There appears to be a new record for a cryopreserved embryo birth. From NPR:
In 1990 a couple underwent In Vitro Fertilization. They eventually had a healthy baby. They also, as is common, had a number of microscopic embryos that hadn’t been implanted, but were viable. They decided to anonymously donate them. Now, one of those embryos has produced a little boy, 20 years after being created.
In other embryo-related news, Colorado has another personhood rights bill (Amendment 62) on the ballot for November:
As used in sections 3, 6, and 25 of Article II of the state constitution, the term “person” shall apply to every human being from the beginning of the biological development of that human being.
So here’s my question: Under the proposed Colorado amendment, would this kid be legal to drink on his first birthday? I’m just sayin’…
Seriously, Colorado — just say “no” to Amendment 62. Its proponents plan to use it to try and outlaw birth control pills and IUDs.
*This blog post was originally published at tbtam*
October 16th, 2010 by Dr. Val Jones in Opinion, True Stories
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Every once in awhile I have the distinct “pleasure” of being a patient. This week I was reminded about how awful it is. I didn’t mind the blood draws, poking and prodding, injections, or interaction with my physician, but it was the rudeness of the ancillary and administrative staff that really got under my skin. I had forgotten how unfriendly people can be, and how especially hard it is to deal with when you’re not feeling well. Context is everything when it comes to rolling your eyes and sighing heavily. Let me explain.
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