January 29th, 2011 by KevinMD in Health Policy, Opinion
No Comments »
I recently pointed to a BMJ study concluding that pay for performance doesn’t seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying: “Money isn’t everything, even to doctors.”
So much is riding on the concept of pay for performance, that it’s hard to fathom what other options there are should it fail. And there’s mounting evidence that it will.
Dr. Aaron Carroll, a pediatrician at the University of Indiana, and regular contributor to KevinMD.com, ponders the options. First he comments on why the performance incentives in the NHS failed:
Perhaps the doctors were already improving without the program. If that’s the case, though, then you don’t need economic incentives. It’s possible the incentives were too low. But I don’t think many will propose more than a 25 percent bonus. It’s also possible that the benchmarks which define success were too low and therefore didn’t improve outcomes. There’s no scientific reason to think that the recommendations weren’t appropriate, however. More likely, it’s what I’ve said before. Changing physician behavior is hard.
So if money can’t motivate doctors, what’s next? Physicians aren’t going to like what Dr. Carroll has to say. Read more »
*This blog post was originally published at KevinMD.com*
January 27th, 2011 by RyanDuBosar in Health Policy, News
No Comments »
Short and sweet. That’s how President Obama addressed healthcare reform in his State of the Union address [Tuesday] night. In less than 700 words, he outlined how he’d improve but not retreat on what’s been enacted into law.
He’s willing to work on changes, he said, naming malpractice reform and reducing onerous paperwork burdens for small businesses. But, he cautioned, “What I’m not willing to do is go back to the days when insurance companies could deny someone coverage because of a pre-existing condition.”
President Obama had invited two real people to his address to highlight the law’s successes. One is a brain cancer survivor who can access health insurance through high-risk pools created by the law. The other is a small business owner who lowered health insurance costs by $10,000 for his nine employees, a probable jab at the “job-killing” title of an attempted yet futile repeal vote last week.
The President’s remarks come at a time when the public is of two minds on healthcare reform. While many state they don’t like the entire package, they also love individual aspects of it. The individual mandate remains widely unpopular, but allowing those with pre-existing conditions to access insurance is widely popular, as does Medicare and Social Security.
The Republican response by Rep. Paul Ryan, R-Wis., Chairman of the House Budget Committee, responded that, “The President mentioned the need for regulatory reform to ease the burden on American businesses. We agree — and we think his healthcare law would be a great place to start.” The House has voted for a repeal and Senate Republicans are preparing legislation and promising to ask for a vote. (Los Angeles Times, Politico, Kaiser Health News, Greenville [South Carolina] Online)
*This blog post was originally published at ACP Internist*
January 25th, 2011 by DrRich in Health Policy, Opinion
1 Comment »
While DrRich is a conservative American, and has made plain the difficulties he has with the Progressive program in general and with Progressive healthcare reform in particular, at times he is forced to admit that, on occasion, the Progressive way of looking at the world has certain merits. And as DrRich contemplates a question that has been bothering him lately, a question that no doubt plagues many American physicians who (unlike DrRich) are still toiling away in the trenches, he finds that this is one such occasion.
That question is: Just who are the people writing all those clinical guidelines — the “guidelines” physicians are now expected to follow in every particular in every case, on pain of massive fines, loss of career, and/or incarceration?
DrRich is quick to say that the act of creating clinical guidelines is not inherently evil, and indeed, back in the day when guidelines were merely guidelines (instead of edicts or directives that must be obeyed to the last letter), creating clinical guidelines was a rather noble thing to do.
But today, we have physicians clamoring to become GOD (Government Operatives Deliberating) panelists. These aristocrats of medicine will render the rules by which their more inferior fellow physicians, the ones who have actual contact with patients, will live or die. Clearly positions of such authority will be very desirable, and so, as one might predict, they are being vigorously pursued. And we are seeing candidates audition for these panels with efforts ranging from amateurish to ruthless. It puts one in mind of the early-season contestants on “American Idol.” Read more »
*This blog post was originally published at The Covert Rationing Blog*
January 23rd, 2011 by admin in Opinion, True Stories
No Comments »
This is a guest post by Dr. John Schumann.
**********
In 2011, the first wave of baby boomers will turn 65 years old. Sixty-five still has currency because that’s the age at which non-disabled Americans are eligible to be covered under the Medicare program (now itself having reached middle age).
As our economy continues to recover (hopefully) from the Great Recession, the entrance of millions of Americans to the Medicare rolls over the next decade and a half will be a formidable planning challenge. Look at this chart to see how the baby boomers population has surged:
So is the promise of healthcare reform (the “PPACA“), which will enlarge Medicaid by an additional 16 million Americans — about half of the projected growth in coverage for those currently uninsured.
A couple of recent patient encounters got me thinking about these phenomena, and how we are very much in historically uncharted territory. Never have we had so many living so well for so long. We have an entire generation of people reaching “seniority” who will continue to want the most out of life, without many guideposts on how to achieve it. Read more »
*This blog post was originally published at ACP Internist*
January 20th, 2011 by RyanDuBosar in Health Policy, Research
No Comments »
While public opposition to healthcare reform has diminished since its passage, physician opinions are still negative, especially among specialists who see their value to the healthcare system decreasing as reform emphasizes primary care.
A survey reports that 65 percent of nearly 3,000 physicians in all specialties said the quality of healthcare in the country will deteriorate in the next five years. Seventeen percent of respondents believe the quality of healthcare will stay the same and 18 percent believe it will improve. Meanwhile, 30 percent of healthcare consumers believe that the quality of healthcare will improve.
Physicians cited as reasons for their pessimism personal political beliefs, anger at insurance companies and a lack of accurate planning in the reform act. Other reasons include that primary care physicians won’t have the time to keep up with the extra workload, forcing more patients to depend upon nurse practitioners for primary care. When asked who will likely handle the 32 million Americans expected to receive healthcare following passage of the reform, 44 percent said primary care physicians will handle the load and 44 percent said that nurse practitioners will see them. (Physicians could vote for more than one category; options include physicians assistants and specialists, for example.) Read more »
*This blog post was originally published at ACP Internist*
