December 27th, 2011 by GruntDoc in Health Policy, Opinion
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This article and its graph (from the NEJM), and its interesting, informative but probably useless graph, was referenced today on twitter, via the Washington Post’s Wonkblog,
Recently, the Centers for Medicaid and Medicare Services announced a scheduled cut in Medicare physician fees of 27.4% for 2012. This cut stems from the sustainable growth rate (SGR) formula used by the physician-payment system. …
To illustrate the level of inequity in this system, we broke down the national spending for Medicare physician services by state and by specialty and determined which states and specialties have contributed most to the SGR deficit between 2002, when the program was last balanced, and 2009. Although SGR spending targets are set on a national level, we computed state targets by applying the SGR’s national target growth rate to each state’s per capita expenditure, using 2002 as the base year. Our analysis is an approximation, because, unlike the SGR, we do not adjust for differential fee changes. …
We compared the state targets for the years 2003 to 2009 to actual state expenditures and added the annual difference between these figures to get a cumulative difference between the state’s spending and the SGR target. This cumulative difference was Read more »
*This blog post was originally published at GruntDoc*
September 23rd, 2011 by BobDoherty in Health Policy, Opinion
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Many physicians, and especially primary care physicians, aren’t happy campers. Why should they be? They feel disrespected, overworked, over-managed, and underpaid. They tell me they wouldn’t advise their children to go into medicine. Some feel that physicians are singularly beset upon. “Our government acts toward the medical profession in an abusive fashion. No other industry or profession is humiliated in this way,” writes RyanJo, a frequent commentator to this blog.
I can appreciate why many physicians are upset. They’ve had a decade where the Medicare SGR formula repeatedly has threatened to cut their fees, only to have Congress enact last minute reprieves that replace the cut with a small token increase that has not kept pace with their costs. Last year, Congress actually allowed the cut to go into effect and then retroactively restored it, creating havoc in physicians’ offices during the four weeks when they weren’t being paid. Like Charlie Brown and Lucy’s football, they are told each year by their members of Congress that that “this will be the year when the SGR will finally get repealed, really, for sure, we promise, this time will be different”–only to see it pulled away at the last minute.
In the meantime, they are constantly hounded to be more accountable for the care they deliver, to fill out just another form, to document their encounters, to get Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
August 6th, 2011 by Medgadget in News, Research
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Researchers from Columbia University have developed a “lab on a chip” HIV and syphilis test, and are now reporting the first results from tests in the field conducted in Rwanda. The mChip, as it is called, is the size of a credit card and replicates all steps of an ELISA test, at a lower total material cost and within 20 minutes. After application of a blood sample, the chip is inserted into a $100 battery-powered handheld analyzer. It needs only 1 μl of unprocessed whole blood and does not require any user interpretation of the signal, providing a clear-cut yes or no result.
Right now, HIV testing in developing countries either relies on expensive laboratory testing taking a long time, or uses cheaper methods based on lateral flow, which, although very rapid, do not provide very reliable results. The mChip combines Read more »
*This blog post was originally published at Medgadget*
March 7th, 2011 by Elaine Schattner, M.D. in Health Policy, Opinion
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[Recently] a short article in the New York Times, New Kidney Transplant Policy Would Favor Younger Patients, [drew] my attention to a very basic problem in medical ethics: Rationing.
According to the Washington Post coverage, the proposal comes from the United Network for Organ Sharing, a Richmond-based private non-profit group the federal government contracts for allocation of donated organs. From the Times piece:
Under the proposal, patients and kidneys would each be graded, and the healthiest and youngest 20 percent of patients and kidneys would be segregated into a separate pool so that the best kidneys would be given to patients with the longest life expectancies.
This all follows [the recent] front-page business story on the monetary value of life.
I have to admit, I’m glad to see these stories in the media. Any reasoned discussion of policy and reform requires frank talk on healthcare resources which, even in the best of economic times, are limited.
*This blog post was originally published at Medical Lessons*
February 16th, 2011 by Glenn Laffel, M.D., Ph.D. in Better Health Network, Research
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Humans are the only living things that cry when they are overcome with emotion. Why do we do this?
A study by Noam Sobel and colleagues at the Weizmann Institute provide part of the answer, at least as it relates to women. The scientists showed that when men get a whiff of women’s tears, they experience a temporary, generalized loss of libido and a dip in testosterone. Really. (And you thought that red, runny nose was the turn off, didn’t you?)
Scientists have known for decades that the chemical composition of “emotional tears” differs from tears shed due to simple irritation. But now, it appears that some of the chemicals contained in the former are actually pheromones; biological substances that create behavioral changes in others who are exposed to them. Such chemicals were known to exist in urine in anogenital gland secretions (dont ask), but not in tears.
Sobel’s team began its study by posting ads on Israeli college campus bulletin boards in which they sought volunteers who cried easily. Seventy-one people responded. All but one were women. From that group, the scientists identified six who were profuse criers and who could return to their labs every other day.
The scientists then asked each one to select a movie that was guaranteed to make them break down, to watch it in private, and to collect their tears in a vial. For the controls, Sobel’s group trickled a saline solution down the same women’s cheeks and collected that. Sobel’s group subsequently asked male volunteers to sniff the contents of the two vials and ran a battery of psychological and physiological tests to measure their responses. Read more »
*This blog post was originally published at Pizaazz*
