Brent Nyitray
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Let the mutherfuker burn!
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Kevin S. Willis
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ScottC
yellojktI wanted to put this post up last week, but got distracted by work and my one month old son (he’s great by the way). So some of this is a week or two old and I don’t have much time to add a bunch of analysis, but I thought some of these may provoke some discussion or just be informative to those who are interested.
The American College of Physicians encourages physicians to take into account the cost-effectiveness of their treatment decisions. In their ethics manual (which you can access for free), the ACP does more than just argue that physicians should take into cost effectiveness with regard to exposing patients to excessive, unnecessary or potentially harmful treatments. The manual encourages physicians to think about how cost effective care can increase the availability of health care to more people. Now I’m all for more cost-effective health care, but I’m not sure I want my physicians worrying about how a treatment they are ordering for me may somehow reduce health care resources available to the community as a whole.
USA Today recaps some of the provisions of the ACA that have already had an impact. It’s not exactly a critical look at the law (OK, it’s pretty much a puff piece), but the government’s success in fighting fraud has gotten more attention lately and the article leads with that aspect of the ACA. While the Obama Administration deserves some credit for the crackdown on fraud, I would also point to the increased use of electronic medical records as a reason for the increase in fraud prosecutions.
The Washington Post has a depressingly humorous article about doctors complaining that the Medicare “doc fix” was closer to becoming a reality than ever. So they’re complaining that the perpetually scheduled reimbursement cut that they know Congress will never pass was closer to passing this time than in the past. Boo-freaking-hoo. The refusal of Congress to pass the cut in physician reimbursement under Medicare is of great amusement to me and NoVa, but it’s emblematic of why we need to fundamentally change our health care system.
The Detroit Free Pressdiscusses all the merger activity between solo hospitals and larger health systems. One of the criticisms of the ACA and programs like ACOs was that they would lead to mergers which would lead to less competition and higher prices. To a large extent mergers were occurring before the ACA so it’s a bit difficult to determine to what extent the ACA increased that activity. It’s also difficult to determine whether or not the mergers will lead to higher prices. The argument that they won’t is that consolidation will lead to increased efficiency which will lower health care spending. It remains to be seen whether or not one or both of those theories will be true.
Lastly, here’s a link to the government’s anti-trust complaint against Blue Cross Blue Shield of Michigan (BCBS). It provides an interesting (albeit one-sided) read. As a brief summary, BCBS entered into most favored nation (MFN) agreements with hospitals throughout Michigan that required the hospitals to charge other insurers as much or more than they charged BCBS. Since BCBS has such a large share of the insurance market here in Michigan that made it hard, if not impossible, for some insurers to compete. And obviously it drove prices up for everyone, including BCBS. Both Michigan and the Feds are in on the suit and several private insurers have filed similar suits.
Filed under: health insurance, healthcare |
All Things in Moderation 
" Now I'm all for more cost-effective health care, but I'm not sure I want my physicians worrying about how a treatment they are ordering for me may somehow reduce health care resources available to the community as a whole. Why do you hate your community? 🙂
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ashot:Thanks for the links.As an aside, the attendings in my division preach cost-effectiveness to their fellows/residents, albeit with more emphasis on the effectiveness part. Our division head is not a fan of the new expensive biologics that show marginally better efficacy than the old standard treatments. Also, biologics often require a physician to administer them (IVs, etc.).
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A lot of biological are for psoriasis, and there are more effective therapies, like PUVA for example. However, there are significantly more drawbacks vis a vis pt. compliance, ease of use and practioner reimbursement that come into play. Once a day pills are often marginally less effective than 2 or 3 times a day pills, but improved patient compliance often justifies paying the higher price.
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I certainly don't oppose physicians considering cost-effectiveness, but I am not sure what/if any point concern over resources available to the community should come into the equation. As both of you point out, there are so many factors that go into a treatment decision that it's a difficult analysis. However I think reimbursement plays a big role. Troll- Patient non-compliance is an often ignored factor. I am guilty of ignoring it. It is also one of the reasons physicians and hospitals are so hesitant to enter into shared-savings programs where the risk of patient non-compliance falls almost entirely on the providers. Granted patient non-compliance is taken into account to some extent, for instance if cost savings is based on last year's numbers those numbers would include patient non-compliance. Still it's understandable that they are hesitant to be held accountable for something they have little to no control over.
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Re:the post article on the doc fix — this jumped out"even though health-industry lobbyists privately concede that there is virtually no chance Congress will actually let the pay cut take effect"There are plenty of people who publicly acknowledge it won't happen. at least in the trade press.
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" I'm not sure I want my physicians worrying about how a treatment they are ordering for me may somehow reduce health care resources available to the community as a whole."Of course not.But they damn well better when considering others' diagnosis impact on ME.
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ashot:I certainly don't oppose physicians considering cost-effectiveness, but I am not sure what/if any point concern over resources available to the community should come into the equation.I think it should come in at the point when the community is paying for the treatment.Just as the doctor has to concern himself with what I can/am willing to pay as a self-funding patient, so too the doctor will have to concern himself with what the community can/is willing to pay if the community is picking up the tab.
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Scott- Obviously I think that concern should be within reason, but I don't particularly have a problem with that. I think that sort of happens in reverse already with physicians making treatment decisions knowing they'll make a bunch of money off doing so as opposed to thinking it will be of much benefit to the patient. I know it will make me sound like a conservative, but we can't keep acting like everyone is entitled to virtually unlimited health care.
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"but we can't keep acting like everyone is entitled to virtually unlimited health care."You're making progress ashot, now you just have to take out "entitled." Baby steps.
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Man…I thought I used entitled appropriately there. So much to learn.
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ashot:I know it will make me sound like a conservative…Come to the dark side, Luke….
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McWing:You're making progress ashot, now you just have to take out "entitled."I was thinking he needs to remove "virtually unlimited".
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Well, he was acknowledging the elimination of "virtually unlimited," but I'm always closing. I don't want the steak knives.
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Troll:In regards to patient compliance, we just had an interesting discussion about the recent neti pot deaths due to amoebic encephalitis. Apparently, compliance goes way down if doctors insist on distilled/purified/boiled water usage in the neti pots. The question is if the purported benefit of nasal irrigation is worth the potential risk of death by people who use tap water, particularly if you live in Louisiana.Interesting how Immunex/Amgen came out with their new Phil Mickelson ad campaign for Enbrel and psoriatic arthritis almost exactly a year before they lose patent protection …
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"Apparently, compliance goes way down if doctors insist on distilled/purified/boiled water usage in the neti pots. The question is if the purported benefit of nasal irrigation is worth the potential risk of death by people who use tap water, particularly if you live in Louisiana."I'm not sure what you mean by compliance in this instance. If MD insists on pt using distilled pt won't use Neti pot? Or won't use distilled? Almost nobody follows antibiotic regimen but that doesn't Moran it shouldnt be Rx'd for bacterial infection.
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And the Rhuemotology market is intense. Big money at stake for sure.
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you'll love this. rumblings that Obama's recess appointments are going to derail his CMS pick, who is pretty well regarded.
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Won't he just recess appoint the CMS pick then?
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I'm not sure what you mean by compliance in this instance.Patients apparently would rather not use the neti pot than go through the trouble of getting distilled/purified water.
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"Won't he just recess appoint the CMS pick then?"I'd guess that is increasingly likely.
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