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*
November 8th, 2010 by BobDoherty in Better Health Network, Health Policy, News, Opinion
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My image of Pittsburgh has been one of a blue-collar, rough-and-tumble town: Perogies, Heinz ketchup, steelworkers, football, and Roberto Clemente. But an exhibit in Pittsburgh’s airport the other day informed me that Pittsburgh also is the home of the iconic “Mr. Roger’s Neighborhood” — the gentle PBS show that entertained toddlers for generations. Mr. Rogers always started the show off with the following verse:
It’s a beautiful day in this neighborhood,
A beautiful day for a neighbor,
Would you be mine?
Could you be mine?
It’s a neighborly day in this beautywood,
A neighborly day for a beauty,
Would you be mine?
Could you be mine?
I have always wanted to have a neighbor just like you,
I’ve always wanted to live in a neighborhood with you.
So let’s make the most of this beautiful day,
Since we’re together, we might as well say,
Would you be mine?
Could you be mine?
Won’t you be my neighbor?
Won’t you please,
Won’t you please,
Please won’t you be my neighbor?
Fittingly, the same week that I was reminded of “Mr. Roger’s Neighborhood,” the American College of Physicians (ACP) released its “medical home neighborhood” position paper. The paper was developed by a workgroup of ACP’s Council of Subspecialty Societies (CSS), which is comprised of representatives of internal medicine subspecialty societies and related organizations.
Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
November 5th, 2010 by Lucy Hornstein, M.D. in Better Health Network, Opinion, True Stories
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I’ve had a longstanding policy in my office that routine prescription refills will only be addressed during regular office hours. No evenings; no weekends; if you need a refill of your long-term chronic medications, you need to call during regularly scheduled office hours, five days a week. You can leave a message if you like, but you should not expect us to call in the medication until the office is open.
The main reason for this policy has always been medical: prescription medication requires appropriate monitoring. From the moment I hung out my shingle, I’ve made it my habit always to write enough refills on your medication to last until the next time I need to see you. In all likelihood if you need a refill, what you really need is a visit.
The logical reason for the policy is the need to consult the medical record before authorizing refills. And when those records are contained on bits of dead trees on shelves in the office, there’s no way I can access them if I’m not physically there. I’ve been known to drive out to the office at decidedly odd hours for the express purpose of consulting those records so that I can provide appropriate care to my patients. That has always been the bottom line for me, and always will. Read more »
*This blog post was originally published at Musings of a Dinosaur*
November 5th, 2010 by Davis Liu, M.D. in Better Health Network, Health Policy, Health Tips, News, Opinion
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The Sacramento Bee recently ran the following opinion piece of mine below. A couple of additional comments not published follow. Enjoy.
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Viewpoints: Choice of health plan can be a lifesaver
It’s that time of year when most of us pick a health insurance plan based simply on cost. It’s a belief that is often perpetuated by friends, family, and advice dispensed by many articles in magazines and newspapers. As a practicing primary care doctor, I can tell you that the advice is frankly wrong.
Health insurance isn’t a commodity like auto insurance. It’s not just about the price. They aren’t all equally good at keeping you healthy and well. The recent annual report by the National Committee of Quality Assurance, which has been evaluating health plans for twenty years, continues to report tangible differences among health insurance plans across the country as well as in California.
In a ranking of 227 HMO plans nationwide in important areas like immunization rates for children, appropriate use of antibiotics, blood pressure and cholesterol control, cancer screening in adults for breast cancer, cervical cancer, and colon cancer, only two of nine California HMO health insurance plans ranked in the top 15 percent. The remaining seven were in the bottom half. If all health plans across the country performed at the level of the top 10 percent, 186,000 Americans would be alive today. They would have consistently and routinely received the preventive care and medical interventions that have proven to save lives. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
November 3rd, 2010 by Shadowfax in Better Health Network, Health Policy, News, Opinion, Quackery Exposed
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Interesting [recent] front-page article in the Wall Street Journal (WSJ) about the American Medical Association’s (AMA) Relative Value Scale Update Committee (RUC). From the WSJ:
Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars.
The group, convened by the American Medical Association, has no official government standing. Members are mostly selected by medical-specialty trade groups. Anyone who attends its meetings must sign a confidentiality agreement. […]
The RUC, as it is known, has stoked a debate over whether doctors have too much control over the flow of taxpayer dollars in the $500 billion Medicare program. Its critics fault the committee for contributing to a system that spends too much money on sophisticated procedures, while shorting the type of nuts-and-bolts primary care that could keep patients healthier from the start — and save money.
I’m glad to see the RUC getting some much-needed scrutiny, and skeptical scrutiny at that. But they miss the point with the “fox watching the henhouse” angle, or at least they paint with too broad a brush. Read more »
*This blog post was originally published at Movin' Meat*
