"Hospitals Not-Profit Full"

Was Zach of 'Rage Against the Machine' implying what we're all thinking now?

How many non-profit hospitals/hospital systems truly deserve their non-profit status?

Should they be competing with the for-profit systems in the same way?

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.

How can it be possible to have true health care reform without saying 'no' to some things???

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."

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.

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!

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.

1. 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.
2. 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.

Even thought they're cheaper, I'm not convinced that they are safer or provide better service.

(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.)

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.

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.

Bring Back Managed Care to Revive Massachusetts Plan

Align incentives to reward people for keeping patients healthy?

Capitation?

Really?

Duh.

Medicare Advantage Plan Spending

"Of the monthly per-beneficiary payments to MA plans, 87% is used for medical expenses, or $683 of $783 per beneficiary per month, according to the report. About 9%, or $71 per beneficiary per month, is used for nonmedical expenses, including administration, marketing and sales. About 4%, or $30, is considered profit, the report found."

Read the Kaiser Daily Policy Report here.

Yes. Health Care IS a Dysfunctional Market.

Yeah, yeah. We know health care is a dysfunctional market.

The consumer doesn't know the cost (or quality, or value) of the services they receive. They're also distanced from directly paying for the services. Physicians, nurses, attorneys, and everyone else attached to this dysfunctional system, in general, can waste resources without an immediate direct impact.

Of course, we know that this is a huge reason for overspending in health care.

Now stop fucking whining and do something about it. All the whining is boring the shit out of me. All of my own whining is boring the shit out of me, for that matter.

Warning to Medicare Advantage Plans: Watch Out!

Looks like CMS and Pete Stark have these plans in the cross-hairs.

It's true that the FFS/PPO versions of these plans have much higher costs (and much higher profit margins for health plans). I just hope that the more tightly managed HMO versions don't get hit.

Single-Payer versus Universal Health Care--Graham vs Porter/Teisberg

Single-payer options have a lot of merit, from both an economic standpoint and from the standpoint of moving towards a healthier society.

Check out this fantastic single-payer animation (which apparently was done by a doc while still in school).

My only adaptation of a single-payer approach would be that any such approach much ensure adequate competition, as discussed in more detail by Michael Porter and Elizabeth Olmstead Teisberg in their book Redefining Health Care.

In their book, the authors do conclude that traditional single-payer approaches can't/won't solve our problems, but state that the reasons for this are based on the assumption that a single-payer solution will eliminate competition as it has in other countries.  My take is that single-payer health reform and competition are not mutually exclusive.  We have an opportunity to learn from the weaknesses in other single-payer systems, and have experience from the polar opposite to design a "single-payer 2.0" option.

However you feel about single-payer, the authors provide a very nice and very thorough description of why universal coverage is essential to solve our problems. 

What a Fuckin' Shame...Katrina Still Haunts Us

Katrina's a fuckin' bitch.

Katrina was and continues to be a bitch.

But it goes beyond the initial death and destruction she caused.

She surfaced issues about race, about corruption, about choices in federal spending (or underspending), about media lies, about the facade that makes us think we're safe and protected by our government....and of course health care.

Mental health issues, stigmatized and under-treated, carry huge cost and societal burdens. And mental health has been underfunded (and has also had shameful access) for a long time.

This has been true for a long time, and it's also very true (magnified 10x) in New Orleans.

Bitch. I wish I could have ignored the problem...

Strong women get a bad rap. They raise issues that the rest of society doesn't want to deal with. They take a stand. They are accused of being unwomanly. And they know their shit. And society calls them "bitches".

Let's fucking listen for a change.

Clinton vs. Obama

Screw mandates....they don't work for a lot of reasons.

But in this brief Clinton vs. Obama excerpt, she's right from an economic/actuarial standpoint (and a health care spending standpoint) on what happens when not everyone participates.

You get adverse selection that hurts everyone that does.

Arrgh! Fuck the RUC!

More on this bitch of an organization from Kevin, M.D.

Read the full piece on the RUC in Family Practice Management here.

Do you think 5 caths (assuming they are actually necessary) should be equal to 80 99214's?

Canadian Health Care Has Too Little Rationing

Canadian health care is not socialized medicine (as I've said before).

It's a single payer system in which there is too little regulation.

In fact, based on my experience in both systems, there is a lot more rationing in our private-based health system. We've got formularies, prior authorizations, referral management, utilization management, tiered copayments, deductibles, different costs for in- and out-of-network utilization.

The Canadian system doesn't have most of that.

Until now. Quebec is considering instituting a co-payment. I think the time is ready for a change in the Canadian constitution to allow for even a nominal co-pay (I actually was surprised to see the $25 amount proposed).

Quebec actually does better in terms of utilization than other provinces.

Just imagine what takes place in provinces such as Newfoundland or New Brunswick, and what would happen if a co-pay were introduced!

In any case, just realize that the Canadian system has problems, but these are actually due to the lack of sufficiently aggressive resource management.

I feel the need to pound it into people's heads that this is not an issue of the system being socialized, nor is it a matter of the system needing the $25 to directly offset costs. It's more to reduce unnecessary utilization.

Natural evolution. They'll do well with this.