Should Dr. Gupta stimulate conversation around a controversial topic (vaccinations), or should he share what he knows (or should know) about the data?
The heated commentary sure increases hits.
Monday, March 17, 2008
Paging Dr. Gupta: The Anti-Vaccine Crowd is Calling
Sick Visits Always Win
Even when patients come in for preventive services, their satisfaction depends on whether or not the "pain" or "illness" that they have at the same time is addressed.
So when someone comes in for a physical, many times they really have something specific they're worried about.
Do you address the preventive care, or do you address the illness?
(Or do you address both and eat the cost of one?)
If you want us to focus on wellness, you've got to pay for it....this is the bottom line.
Medicare Will Pay for "Heart Scans"! WTF?
You've got to be fucking kidding me.
Medicare has agreed to pay for heart imaging studies?
What the fuck?
Let's not pay for things for which there is clear evidence (or at least not pay adequately for them), and let's pay for cardiac imaging, for which there has been no clear impact on morbidity and mortality.
It looks like the American College of Cardiology and the American College of Radiology (along with a number of pseudo-organizations, such as the Society of Cardiovascular Computed Tomography) are our heroes here.
Of course, the rest of us know that they're behind this because it leads to more interventional cardiology procedures. One can never do enough stenting, you know...
In the meantime CVT surgeons are getting screwed, despite the fact that they've got a superior intervention....and the folks that are behind aggressive medical management are REALLY screwed.
This decision so perfectly demonstrates why complete anarchy is necessary to reform our health system. The whole fucking thing needs to be blown up:
- Incentives are skewed to benefit the high-tech proceduralists, independent of evidence.
- The average person is brainwashed to believe that they need these things.
- People get things that they don't need, and they get hurt.
- The system pays for the complications.
- There's little money left for the physicians that do the work to lower costs and improve outcomes for the system.
- Medicare's decision here leads to unnecessary testing and intervention, and thus more intervention without benefit.
Can P4P Programs Increase Racial Disparities in Health Care?
If it meant more money for your work, would you see anyone but white men?
Racial disparities just might be enhanced by pay-for-performance (P4P) initiatives, whether or not they are intentional.
Read the article from Health Affairs.
Healthcare 2.0 and Doctor 2.0: An Interview with Jay Parkinson, MD
Is health care stuck in 1994?
Is the face of the new uninsured/under-insured changing?
How can technology help us?
Wednesday, March 12, 2008
What do You Call a Doc Who Spends Enough Time with Each Patient?
From Kevin, M.D.:
"What do you call an internist who spends enough time with each patient?"(Love the first comment..."What do you call a 50-year-old obstetrician? A gynecologist!")
Poor!
Traditional Medicare is More Efficien than Medicare Advantage Plans? So Says MedPAC Chair Hackbarth
Overall, it may be true.
But the good, cost-effective, high-value Medicare Advantage plans (which often are tightly managed by virtue of a risk-sharing structure) are getting a bum rap by being lumped in with the FFS Medicare Advantage plans.
Guess what?
The fee-for-service versions of these plans aren't managed as tightly, and have more cost! It doesn't take a rocket scientist to figure this out!
From a recent MedPAC report:
"...However, most of the enrollment growth was in private FFS plans—whose enrollment more than doubled last year. Yet, private FFS plans have no requirement to coordinate care or report quality measures, and their payments and inefficiency are even greater (117 percent and 108 percent of FFS) than the MA program as a whole."
Pharmacists Help in Controlling Diabetes
At $60-$90 for a 30-minute session, I'd do it too.
Oh, but then again, I can't as a physician....I'm legally required to accept the Medicare rate (or non-rate, as payment for patient education and prevention is often denied).
The fact that the pharmacy also cashes in on the margin from selling the meds can't hurt either, huh? No Stark Laws here.
Seriously, I think anyone/everyone in the health care team must play a role in chronic disease management, so I'm happy for that. But this phenomenon is one of those un-intended consequences of a dysfunctional reimbursement methodology.
Want to Live Longer? Be White...It'll Be Alright!
Racial disparities in health care continue to be a problem.
Don Berwick has even commented on them.
In the Institute of Medicine (IOM) report, "Unequal Treatment", it's made clear that "...many people of color receive lower quality of care than whites, even when presenting with the same health problems and the same health insurance."
Why the fuck didn't the Department of Health and Human Services want to include this in their recommendations?
("Duh...Gee...I thought those people were all killed off by Katrina?")
Down with the Anti-Vaccinists!
I've said it before...
The anti-vaccinists are selfish bastards, that think nothing of leeching off of the rest of society. Belgium has taken a hard stand on this, and rightfully so, jailing Belgians that refuse polio vaccine.
Polio is a horrible disease. The World Health Organization's efforts at eradicating it started in 1988, and they've done a pretty damn good job: 99% reduction.
Both medical experts and bioethicists agree:
"...unlike other medical problems, in which rejecting treatment only affects the individual, refusing a vaccine for a transmissible disease like polio puts others at risk as well."
"Ethicists argue that people who refuse vaccinations are taking advantage of everyone else who has been vaccinated. Once the majority of a population is vaccinated, there are few susceptible people the disease can infect, thus lowering the odds of an outbreak.
People who refuse to be vaccinated are 'free riders,' Harris said. 'They can only afford to refuse the vaccine because they are surrounded by people who have fulfilled their obligations to the community.'"
So, listen up you fucking selfish dumbshit anti-vaccination cocksuckers! Just because you're rich enough to both "afford" and waste the luxury of health care in this country doesn't give you the right to potentially inflict harm on the rest of the population.
...and once and for all, despite the media bullshit, vaccines don't cause autism.
Bite me...self-indulgent assholes.
Saturday, March 8, 2008
2008 Election: Health Care Op-Ed Summaries
From the Kaiser Daily Report comes a nice summary of recent health policy op-ed pieces related to the election.
Virtual Bundling to Penalize Health Care Wasters
Virtual bundling to reduce payments to wasteful hospitals and physicians is likely to be coming soon from CMS.
It's a payment penalty. It's going to spank those that are inefficient and wasteful, thus depleting our precious health care resources.
I like it.
Even more, I like the concept of redistributing some of these funds to reward those with more responsible resource utilization, but only if this is not the sole variable (e.g., outcomes must also be considered if we want to ultimately reward on value).
I'm not quite sure what the "virtual bundling" concept will look like in practice, however.
Employer-Sponsored Health Care--"The Slick Pickpocket"
From the WSJ Health Blog:
Uwe Reinhardt, a Princeton health economist, likens the employer-based health insurance to a garden party where a very slick pickpocket steals your wallet and then buys you roses and chocolates. “You’d be very grateful,” Reinhardt tells the Health Blog. Employers “are pickpockets who very skillfully take it out of your paycheck. Then they say, ‘Now genuflect.’ ”
We all know this, but it's good to be reminded. Employer-sponsored health care is inefficient and ultimately is offset by salary adjustments, not typically from the profits of the organization.
Health Wonk Review Hosted by Work Comp Insider
Health Wonk Review is a biweekly summary of the best in health policy blog posts and knowledge.
Save Up $225,000 by Age 65 to Cover Your Health Costs
A recent report by Fidelity Investments predicts that a 65-year-old couple retiring in 2008 will need $225,000 to cover medical costs in retirement.
What happens if I'm not retiring until 2020?
Start saving, suckers!
Big Pharma Deals Galore
What's going to happen with big pharma?
A number of players have taken a beating. The time for deal-making is prime.
Check out the "Pharma Deal Bracket" for predictions on what might happen in terms of pharmaceutical industry consolidation.
What will this mean for consumers?
The Shit Is Going to Hit the Fan, Starting in NY
As NY Attorney General Andrew Cuomo subpoenas health plans including Aetna, Cigna, Empire Blue Cross Blue Shield, Excellus, UnitedHealth, WellPoint, and the combined GroupHealth and HIP Health Plan, what will be uncovered.
He's serious about this. He's even requesting all email correspondence at the senior levels of these companies (CEO, CFO, COO, Presidents, as well as employees that supervise the claims process).
What started this? Here's the gist:
- Ingenix is a company that provides the data to help insurers determine rates, including out-of-network rates.
- United Healthgroup owns Ingenix.
- There is suspicion that United Healthcare and other insurance companies may have colluded with Ingenix to manipulate the data in a way that benefits them and hurts consumers (for example, the rates may have been set artificially low for out-of-network reimbursement so that the patient's out-of-pocket portion is much higher).
But I don't accept that conclusion--bullshit. Business ethics is the fundamental problem, and although companies like Enron took center stage, corporate responsibility needs to be more important across the board.
Let's just say, I'm betting that the shit's gonna' hit the fan. Let's hope I'm wrong.
Tuesday, March 4, 2008
General Surgery is Getting Fucked Over as Much as Primary Care
When you can make more from stripping veins than you can from taking out half of someone's colon, something is really fucked-up in the system.
General surgery is the primary care/generalist equivalent among surgical specialties. And they're getting fucked over just as bad.
No wonder we're looking at a shortage here too.
Calling in a Prescription or as Ass-Kicking
This story about a request to call in a prescription is all-too-familiar for many of us.
The best part of this post is the first comment, "It's a shame that you can't call in an ass-kicking for all involved..."
Healthy, Nurtured Kids Lead to Less Crime
Top 10 Health Affairs Blog Posts
Health Affairs kicks ass.
Here are the top 10 posts from the Health Affairs blog.
"I'm Not Fat, I'm Just Big-Boned"
Guess what?
Cut down on TV and computer use, and your "big-boned" kids will magically be right-sized.
Excessive CT Scans and Imaging Cause Cancer
Or at least increase your risks of cancer.
A recent study showed that the average trauma patient receives a workup that delivers about the same amount of radiation as 1,005 chest x-rays.
McCain Believes Vaccines Cause Autism! WTF??
And by the way, he thinks the world is flat too.
Vaccines absolutely do not cause autism, you frickin' moron!
The Reason for Slow EHR Adoption
From the Baltimore Sun:
"One key is incentives. For an individual doctor or a small practice, switching from paper to digital costs between $40,000 and $60,000. For most doctors, this is a lot of money: The average physician pulls in about $150,000 a year. And the savings from going digital mostly accrue to the insurance companies, Merritt said.
'There's no incentive to adopt the technology,' Merritt says. 'No one helps them offset these costs.'"
Yup.
Fuck It...Who Needs Oxygen?
One way to reduce costs is to stop paying for oxygen 13 months after discharge.
Fucking rocket scientists in the Bush administration....
(Especially, because we all know how expensive oxygen is!)
Medicare Cuts Reimbursement 15.4% on 1/1/09
Don't fix the formula, and here's what you get.
(P.S., It'll be handled through the veil of efforts to improve quality and efficiency, with measures that place the burden for this on primary care physicians, without requiring tighter management of specialty referrals and procedures.)
Cap the Greedy Bastards, and Use the Money to Fund Mental Health Parity
Yeah. I'm for this bill.
- Limiting the number of physician-owned specialty hospitals and ambulatory surgical centers will definitely reduce the number of unnecessary procedures being done in these places.
- Mental health has been screwed over for way too long, and the lack of mental health resources ends up shifting costs to the medical side...health care costs go up without mental health treatment.
(FYI...the limits would protect my dumb-ass colleagues that continue to invest in these despite the fact that there's an oversupply in most markets.)
Fucking Airborne...I Tried to Tell My Patients It Didn't Work...Oh Well
Liars and cheaters, watch out. Take a lesson from the makers of Airborne. $23 million is quite a lesson.
More Expensive Pills Work Better, Right?
This MIT study suggests that a placebo at $2.50 per pill relieves pain better than one priced at $0.10 per pill.
Incidentally, it looks like the same is true for wine--the same wine priced more expensively tastes better.
My ass hurts just thinking about the larger macroeconomic consequences of this conclusion.
Good luck explaining cost effectiveness to these folks.
Rich Whining Docs Fight...Health Care Implodes
Check out this rant between the ER docs and the sub-specialists.
Where's the love?
(And do they realize that there are docs even further down the economic totem pole for whom it's not a matter of how much you can make, but rather one of staying in business or not!)
Monday, March 3, 2008
International Health Charity Fills Need in US
Believe it.
Remote Area Medical typically serves those in desperate need of health care in developing countries.
It turns out that there's a huge need here at home.
Their recent weekend outreach in Knoxville, Tennessee treated almost 1,000 people in need, and had to turn away 400 due to the overwhelming response.
I'd hate to see how bad it needs to get before we do something meaningful in health care reform, instead of the watered-down versions in some places (Mass, Colorado).
Sunday, March 2, 2008
FDA Wants More Power
Give the FDA more powers?
Nah...fuck it. I'm against big government.
By the way, I also like shit with my beef, maybe even served with a side of Creutzfeld-Jakob Disease. Prions...mmm.
Should Universal Coverage Even Be an Item on the National Agenda?
Some people don't think so. Check out the article in the NY Times here.
Why Winter is Flu Season
Even docs wonder about the reasons why flu season takes place in the winter.
Personally, I think there are a number of reasons. This recent study adds to the list.
Cool stuff.
(Think M&M's.)
Dumb Ass Thinks We Shouldn't Vaccinate Against Influenza
The problem with the mainstream media is that it's so fucking biased.
I'm glad people are reading. I'm pissed off as hell that the media is feeding information that leads people to make bad choices.
Health Punk spanks someone on ABC's reader comments.
Saturday, March 1, 2008
A New Market for Occupational Medicine...in India?
Check out the problems with repetitive injury that employees at outsourcing firms in India are now dealing with.
We're outsourcing more than we think.
Who Needs Evidence? There's Money to be Made!
Look at this irresponsible campaign recommending that people demand a CT scan.
Bullshit, bullshit, bullshit.
It's enough that this racks up waste and cost in the system. In fact this does actually does harm!
Shame on the oncologists that support this...but then again, since when is oncology evidence-based? There's money to be made!
Flu Shots and Autism? Dumb Asses.
People are so frickin' stupid sometimes.
The CDC recommends flu shots for all kids now.
This story says that parents disagree.
The reasons are bullshit, by the way. Let me clear this up:
- Vaccination does not cause autism (and "Dr. Bryan Jepsen" can't be a real physician--nor an autism expert--base on his suggestion--quackery in mainstream media).
- The vaccination isn't just about protecting kids (the pediatrician interviewed doesn't seem to get this fact either)--it's about preventing it from spreading to the high-risk groups (the elderly, those with chronic diseases, the immunocompromised, etc.) for whom it really is deadly on a wide-scale basis. A great example of selfishness ("it's all about me") in our society.
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