March 22nd, 2010 by Debra Gordon in Better Health Network, Health Policy, Opinion
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My alarm clock is set to “radio” and my radio is set to the local NPR station. Now, I’m not one of those people who leaps out of bed when the alarm goes off. Instead, I lie in bed slowly waking up to about 15 or 20 minutes of the morning news.
This morning however, the news just made me want to pull the covers over my head and never get out of bed. That’s because the focus was healthcare reform, and the amount of misinformation — and, yes, I have to say it: stupidity — out there about what the current proposals will or won’t do is making me literally sick to my stomach. Read more »
*This blog post was originally published at A Medical Writer's Musings on Medicine and Health Care*
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 3rd, 2009 by Shadowfax in Better Health Network, Health Tips, Research
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I love graphs, especially interactive graphs.
GE made a graph of the average annual cost of patients with eleven common chronic diseases. Go check it out, marvel at the coolness as you grab the sliders and spin the wheel o’ misfortune. Take home point: hypertension is the single biggest driver of medical cost in all patients age 33 and up. Go figure.
*This blog post was originally published at Movin' Meat*
September 17th, 2009 by DrRich in Better Health Network, Opinion
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When DrRich left his medical practice nearly a decade ago, he spent much of the next few years as a consultant to certain companies that make implantable defibrillators.
Most of his work was in research and development, and had next to nothing to do with defibrillators themselves, or any aspect of treating cardiac arrhythmias. Rather, DrRich was interested in developing physiologic sensors that could be deployed in implantable devices, and the algorithms that could use these sensors to predict and detect various developing medical conditions (so as to enable early intervention, and potentially prevent said medical conditions from becoming manifest). DrRich considered this work a) interesting, and b) representative of a business model that could potentially flourish within a healthcare system whose chief concern is reducing costs.
And whenever the captains of industry who signed his checks would ask him something about implantable defibrillators, usually seeking his opinion on a proposed subtle variation in some unbelievably complicated programming feature, DrRich’s reply was likely to be something like this: “Sir (or Madam) – I will be happy to study the question you pose to me, as I am working on your dime. But it greatly saddens me to see all this time, energy and talent wasted on adding yet more irrelevant features to a mature technology, in pursuit of a business model that is fundamentally broken.”
To which they would smile indulgently, hand DrRich the document describing the proposed changes, and schedule a meeting to discuss them.
The indulgent smile was in recognition of the fact that DrRich never made a secret of his disdain for the business model embraced by implantable defibrillator companies. The fact that these captains of industry put up with DrRich’s disapproval was a clear indicator that they considered it to be “quaint,” and apparently not worth taking seriously, and that the value DrRich provided in other arenas at least counterbalanced the annoyance of having him criticize their core business every chance he got.
DrRich’s disdain for the implantable defibrillator business model was based on two factors.
First, their business model relies on the artificially high prices the system will pay for their devices. DrRich has discussed this before. While these high prices are not directly the fault of the companies themselves (rather, they are fundamentally the fault of Medicare processes that distort and destroy natural market forces), these companies have now come to rely entirely on this artificial price structure, and have established all their business practices around this high-margin enterprise. The problem is that this high-price model absolutely precludes any reasonable penetration of this life-saving technology into the vast population of patients who might benefit from it. Also, because the price structure is not only artificial but arbitrary, a few simple changes in Medicare processes could abruptly destroy their business overnight.
Second, nobody is really interested in preventing sudden death. It’s difficult to sell any product when there’s no demand for that product, and there is no demand for sudden death prevention. In contrast, most other medical problems have a built-in constituency Read more »
*This blog post was originally published at The Covert Rationing Blog*
June 15th, 2009 by KevinMD in Better Health Network
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A 90-year old man with a pancreatic mass, almost definitely pancreatic cancer, was admitted to a hospital.
Surgeon Jeffrey Parks does the initial surgery consult on this terminal case, and recommends hospice care.
The next evening, he’s shocked by the “astounding amount of medicine [that] had been practiced” during the day:
Consults had gone out to GI, oncology, and nephrology. The GI guy had ordered an MRCP and, based on some mild distal narrowing of the common bile duct, had scheduled the patient for a possible ERCP in the morning. A stat CT guided biopsy of the liver lesions had also been done. The oncologist had written a long note about palliative chemotherapy options and indicated he would contact the son about starting as soon as possible. The nephrologist had sent off a barrage of blood and urinary tests.
It’s often said that we spend the most money in the world on futile care, often with little benefit to the patient. The preceding account was that phenomenon in action, replicated thousands of times on a daily basis.
A microcosm of what’s wrong with American medicine indeed.
*This blog post was originally published at KevinMD.com*
