Brent Nyitray
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Let the mutherfuker burn!
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Kevin S. Willis
Michigoose
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markinaustin
Arcanaut
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quarterback
ScottC
yellojktHere is the first of what I hope to be a weekly post on Health Care. This will be largely oriented towards the legal side of the health care world because that is the information I get on a daily basis. But if anyone, especially, NoVa, wants to add links, please do so.
This is sort of not news because everyone knew it was going to to happen, but the scheduled 27% cut in Medicare fees for doctors is not going to happen. The “Doc Fix”, as it’s commonly known, is going to be part of the payroll tax deal. Maybe NoVa has heard differently, but I think hosptials and physicians know this dance can’t go on forever and that eventually reimbursement rates will be cut.
The administration was bragging about its success in fighting fraud. The DOJ attributes the success to city specific anti-fraud teams. As I’ve said before, a lot of the success is due to the spread of electronic health records.
This is a bit “inside baseball”, but CMS just issued a proposed rule regarding a provision in the ACA that requires providers to report overpayments within 60 days of “identifying” those overpayments. I don’t recommend reading the actual propose rule (unless you have trouble sleeping), but I mention this for several reason. First, it is a big deal for providers. Second, it’s an example of the (slow) legislative process. The ACA was passed 2 years ago and we are just now getting regulations on this aspect of the law. This is just the proposed rule after which people submit comments. After reviewing the comments, a final rule will be published. Lastly, it is an example of something posters have talked about here, where an unelected body (CMS) is, to a large extent, legislating. I don’t necessarily agree with some of the viewpoints expressed on that topic, but I think it can lead to an interesting discussion. [Also of note is the look-back period. CMS wants it to be 10 years, which is unheard of. Currently, CMS can reopen a claim within 1 year of payment for for any reason and within 4 years is “good cause” is shown – NoVA]
According to CMS and HHS 86 million Americans took advantage of the “free” preventative services required by the ACA. The quotes around free are mine since I’m pretty sure we’re paying for these one way or another. As NoVa has pointed out several times, there is also a question as to the efficacy of these preventative treatments.
Speaking of preventative care, at least one insurer is increasing reimbursement for primary care doctors. According to the article, the plan is supposed to pay for itself through decreased ER visits and hospital admissions.
This focus on preventative care is part of a broader trend towards ephasizing wellness. In addition to cheaper and more efficient treatment of chronic and acute conditions, hospitals and doctors are going to try and keep people healthy. Why? Because under payment models like Accountable Care Organizations, hospitals well earn money if they get you out of the hospital faster or prevent complications from arising once you are in the hospital. But they will earn even more money if you never come to the hospital or doctor. While it’s nice to see the current incentives (more care = more money) turned on their head, there still seems to be incentives (other than good health) for health care consumers to buy into this. As things stand, providers will laregely be held responsible for patient non-compliance. Needless to say, that is a concern for hospitals and doctors.
A couple more random links: The Washington Times demagogues the daylights out of ACOs. I could spend a long time pointing out the errors in that article. Meanwhile, Forbes talks about how private insurers are adopting some of the payment models in the ACA.
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An article from the New England Journal of Medicine about the new American College of Physicians ethics manual guidelines of “parsimonious care” and how that relates to health care costs.
— Mike
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Here’s a link to the WSJ editorial QB referenced in his comment. I am familiar with the Center for Medicare and Medicaid Innovation, but not at all familiar with this task force. While I’m unlikely to see it as the menace QB does, I do appreciate being made aware of it.
Filed under: Uncategorized |
All Things in Moderation 
Thanks, ashot/NoVA. I’m looking forward to this becoming a regular feature. I might throw in a link/blurb once in a while as well.
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ashot and NoVA, thanks for this. I’ll dive in tomorrow if I have a little time.
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Many thanks to both of you (ashot and nova) for taking time to do this. You’ve both done a great job of keeping us informed, but I like having it categorized in a weekly or monthly post, kind of like the much-valued Morning Report.
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This was so good.
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Second, third, fourth and fifth the above comments–greatly looking forward to the future posts, and thanks for this one. Great work!
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There was an interesting op ed in the WSJ this week about the role and power of the United States Preventive Services Task Force in dictating which procedures must and can be covered in the new one-size-fits-all, mandatory, government-regulated world of health insurance under Obama.
It also fits nicely with the Rove column on Obama and other people’s money. His observation there is entirely unoriginal but well said: Obama’s game is giving out “free” goodies. Free to him, costly to those of us in the narrow slice of the public he seems monomanically focused on looting to pay for the free ponies and cotton candy.
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There’s a lot of interest in the USPSTF. both in working to make sure your item/service gets that A or B rating and in nominating who is on the panel.
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Given my practice it sort of makes sense that I haven’t heard much about USPSTF. Howver, it would makes sense for providers to pay close attention and expand marketing efforts and service lines in areas where the USPSTF mandates insurance coverat. I do recall you mentioning this before NoVa. This is a lobbyists dream committee, right? If a lobbyist gets a client’s services listed the lobbyist is a hero.
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qb, I have no problem with you paying for my ponies and cotton candy, although I do wish you’d upgrade me to a unicorn! 🙂
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I think you in luck, michi. Pretty sure that is in the new Obama budget.
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“If a lobbyist gets a client’s services listed the lobbyist is a hero.”
Yep. Look at this way. If I can get my new test that A/B rating, there’s no reason for every doc in the country not use it. i’m actually working on this for a client. we want our screening tool* to be part of the “welcome to Medicare” exam, which would REQUIRE them to use it — and i think it’s something like 7000 boomers a day become eligible for Medicare.
*it’s actually a good test and not, you know, evil. it’s series of questions that would lead a doc to our remedy, if warranted.
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it’s actually a good test and not, you know, evil. it’s series of questions that would lead a doc to our remedy, if warranted.
Whatever helps you sleep at night, NoVa. Although I suspect that giant pile of money you sleep on is more helpful than your rationalization above.
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“Although I suspect that giant pile of money you sleep on is more helpful than your rationalization above”
Scrooge McDuck was full of it. You can’t swim through the stuff at all. and it’s like sand. gets everywhere.
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and it’s like sand. gets everywhere.
Ack! The mental image!!!!! 🙂
Plus 1,000 on your new avatar, BTW, all kidding aside.
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Scrooge McDuck was full of it. You can’t swim through the stuff at all. and it’s like sand. gets everywhere.
Indeed.
http://www.youtube.com/watch?v=tMyk7MXsseg&w=420&h=315
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I think you in luck, michi. Pretty sure that is in the new Obama budget.
Yeah, but it all gets revised away after the election. 😉
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“Kevin S. Willis, on February 17, 2012 at 8:33 am said:
I think you in luck, michi. Pretty sure that is in the new Obama budget.
Yeah, but it all gets revised away after the election. 😉 ”
I’m waiting for free gasoline to be mandated as part of auto insurance coverage and free lawn care to be mandated as part of home owner’s insurance coverage.
Then we can have the Congressional investigation about why those insurance rates suddenly spiked. Must be price gouging.
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Good write up.
“According to CMS and HHS 86 million Americans took advantage of the “free” preventative services required by the ACA. The quotes around free are mine since I’m pretty sure we’re paying for these one way or another. As NoVa has pointed out several times, there is also a question as to the efficacy of these preventative treatments.
Speaking of preventative care, at least one insurer is increasing reimbursement for primary care doctors. According to the article, the plan is supposed to pay for itself through decreased ER visits and hospital admissions.”
Sarah Kliff from Ezra Klein’s Wonkblog had a piece on this:
“What if prevention doesn’t save money?
Posted by Sarah Kliff at 12:51 PM ET, 12/11/2011
The idea that preventive health care saves money is among the most ubiquitous and bipartisan health policy ideas out there. It’s an idea that numerous contenders for president in 2008, Democrat and Republican, endorsed. Prevention, President Obama has argued before Congress, “makes sense, it saves money, and it saves lives.” A recent poll found 77 percent of Americans believe that prevention saves money, with 56 percent believing so strongly.
What if we’re all wrong? What if prevention doesn’t save money?”
http://www.washingtonpost.com/blogs/ezra-klein/post/what-if-prevention-doesnt-save-money/2011/12/11/gIQAM60OnO_blog.html
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“however, discounts all the mammograms that didn’t detect cancer and didn’t prevent anything and all the individuals for whom weight management programs didn’t work. All those costs add up to the point that most preventive interventions cost more than they save.”
The key is you have to target your interventions. Screen those at risk not the entire population. but, we’ve politicized health care to the point where you can’t make that point without the offended patient group and their champions from protesting.
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NoVA:
The key is you have to target your interventions.
Yeah, the docs are all talking about “personalized medicine,” especially since the price of genome sequencing has come down to ~$1000/genome. It’s probably 5 – 10 years off, if we can come up with a reasonable set of ethics to govern the dissemination of the genomic information.
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Mike-
Thanks for your contribution to this post. I am not particularly in touch with how physicians see many of these issues as I mostly represent hospitals and health systems so your perespective is appreciated.
Of course, as soon as you suggest that interventions be targeted, you are rationing care and the shadow of death panels grows larger.
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The key is you have to target your interventionsI
It’s why I stopped getting mammos (after two highly scary false positives) a few years ago, and don’t plan to start getting them again for at least five–if not 10–years. No reason to spend the $$$, and it just wastes my time and the technician’s time. I’m not at risk either genetically or statistically, so why bother?
And mine are fully covered by insurance. I think that there are actually many of us out here who don’t get stuff done simply because it’s “free”, so the argument that ACA will increase costs by increasing access falls flat with me. What I AM worried about, and I can’t remember who here brought it up, is that we’re going to bump into a fairly significant primary care provider shortage in the near term.
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after two highly scary false positives
This was one for the reasons cited by the task force for changing the recommendations. Needless suffering outweighed the benefit. They did exactly what they were supposed to do — weigh the evidence and make a decision backed by the science. And their reward was to be ripped to pieces. We’ve politicized the panel and can expect future decisions to be made with political justifications in mind.
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We’ve politicized the panel
Unfortunately, yes, and this is another one of those areas that I part ways with my Komen sisters. I understand their point, but I also understand the science,and it often doesn’t coincide. It’s an uphill battle that I’m fighting within that community, but the problem is that whenever you’re arguing within an advocacy community you’re arguing against an anecdotal argument. . . and everybody has a tale of how the system didn’t work for them.
Hence why we should mandate personal health insurance and use a single-payer system! 🙂
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Its funny how we can diagnosis the problem and come to radically different solutions. of course, yours isn’t really a solution. 🙂
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To NovaH and Michigoose:
Going back to Novah’s posted link to Front Line, it seems obvious that single payer is not the only solution, nor the one that we will eventually adopt.
On the provider shortage, most recently I posted a link to an article that claims ACA contains no increase in Medicare funding to pay new residents, most of whom are funded by Medicare. If ACA is to break the non emergency poor patient’s dependency on the cost ineffective ER, there will have to be clinics with providers available.
Suppose instead of ACA or any similar program Congress had simply decided it was time to subsidize MD, DO, RN, PharmD, OD, and DDS education in return for loans forgiven if the provider does four years of work in a public health clinic, public school system, community non profit clinic, military, VA,or similar system, for a reasonable but not lavish salary. Do you think we would raise the supply of primary care providers? Do you think we would lower actual medical costs? I do. I would trade out having the labor and infrastructure in place to lower medical costs for an insurance “reform” package every time, and I think it would be, or would have been cheaper. Whatever attempt that was later made to move closer to universal coverage would have had a better chance of success.
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Do you think we would raise the supply of primary care providers? Do you think we would lower actual medical costs?
Yes. We made the wrong investment. Instead of infrastructure — docs, affiliated providers, clinics — we put our resources in expanded access to health insurance, which I maintain is properly used as a financial product for those who wish to protect assets from unforeseen medical expenses.
So we’re left with:
Marginal reforms to Medicare. We’ll tinker with it, slice here and there, but I’m convinced it will have to be the Dems who make the switch from the “such sums as may be necessary” nature of the Social Security Act to something else. And they won’t until they have to because it’s good politics for them. “Ending medicare as we know it” should be a plea for reform, not a slur. Coburn introduced a Medicare reform bill yesterday, but I haven’t looked at it yet.
Building on employer-sponsored insurance. I appreciate the desire to leave the system as is for most. But was the wrong policy call and it’s not as if the current system is at all popular. You’re saddling employers with costs they don’t want, limiting consumer choice to employer-approved plans, and engaging in pointless debates what what has to be included for “free” — most of which is about services that are neither unexpected or catastrophically expensive. what a colossal waste of time and resources.
If politicization of health care is a problem, and it is, single payer is doubling down on that.
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ashot:
You’re welcome. Thanks for getting the ball rolling.
The following sentence from a WaPo article struck a chord with me, as I was just discussing end-of-life care with the MD fellow in my lab.
“For many Americans, modern medical advances have made death seem more like an option than an obligation. We want our loved ones to live as long as possible, but our culture has come to view death as a medical failure rather than life’s natural conclusion.”
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jnc:
Then we can have the Congressional investigation about why those insurance rates suddenly spiked. Must be price gouging.
Heh.
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“What if we’re all wrong? What if prevention doesn’t save money?”
I suspect the flaw is not in preventative care so m
uch as in patients’ willingness to follow doctors’ orders to eat better & exercise more.
Getting earlier screening for diabetes (for example) is pointless if people aren’t going to change their behavior.
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