Consumer Focused Health

The Senate decided to close debate on the “doc fix”, setting the stage for the death spiral of Medicare.  Already paying below market rates, expect that a substantial number of physicians walk away, as they face a river of red ink from practices being asked to work for free (or less).

June 17, 2010 — In a last-minute shock to physicians, the Senate voted today against postponing a scheduled 21% reduction in Medicare reimbursement to physicians and other health providers.

A compromise proposed by Sen. Max Baucus (D-MT) was defeated largely along party lines, with no Republican support. The compromise was put forward after the Senate had rejected a $140 billion finance package yesterday that would have delayed the cut in Medicare payments to physicians until 2012, along with measures to extend unemployment benefits and provide $24 billion to states to cope with their Medicaid programs.

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Congratulations to new Massachusetts Senator Scott Brown.  We saw health care concerns drive the election of a Republican in the bluest of states.

Yet, most people want health care to be reformed…its not that we don’t want change…its that the current approach to ObamaCare looks to lock out change and lock in an insurance model that people can neither comprehend nor afford nor trust.  As Albert Einstein once remarked, “Insanity is doing the same thing over and over again and expecting different results.”

So what is the right model for health reform?  My humble suggestion is that our nation yearns for Health Assurance, not just Health Insurance.  What does that mean?

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All you oncologists out there should find this one interesting — an infectious cancer in Tasmanian devils that originated in a single animal’s Schwann cells and is spreading via “direct contagion” to other animals.

Cancer as parasite is an analogy I’ve been aware of, but I’ve never seen a cancer spreading between animals as a direct parasite (generally contagious spread is a result of viral hijacking causing changes in DNA that then leads to cancer).

Interesting — and potentially a disruptive way to think about cancer biology.

Scientists Report Findings on Origin of a Cancer in Tasmanian Devils – NYTimes.com.

The Tasmanian devil, the spaniel-size marsupial found on the Australian island of Tasmania, has been hurtling toward extinction in recent years, the victim of a bizarre and mysterious facial cancer that spreads like a plague.

Now Australian scientists say they have discovered how the cancer originated. The finding, being reported Friday in the journal Science, sheds light on how cancer cells can sometimes liberate themselves from the hosts where they first emerged. On a more practical level, it also opens the door to devising vaccines that could save the Tasmanian devils.

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Have you visited a MinuteClinic or other retail health clinic?  This approach to health care is transparent (prices clearly posted and generally cheaper than physician visits), convenient (located in a pharmacy or other retailer), and customer-friendly (walk-in appointments easy to find).

So why are these clinics, which customers love, struggling?

The answer is surprisingly simple: Medicare (and by proxy, other health insurers) have created a payment system that starves innovators because:

1. they can’t charge more for providing better service
2. there’s no reward for customers who select a cheaper service
3. they can’t even bill customers for innovations that achieve better results and reduce the need for further services

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Doctor Availability Declining with Cuts (via Health Care BS)

Are Primary Care Physicians (PCPs) finally willing to say no to the Fee for Service Medicare approach that has destroyed their practices and profession?

The Mayo Clinic in Arrowhead, Arizona fires a shot across the bow, by informing patients that they will no longer accept Medicare for their primary care doctor visits as of Jan 1 (via Dr. Wes and AZcentral.com)

The discrepancy between what Medicare pays and our cost of providing care acutely impacts the sustainability of our primary care practice. Medicare reimbursements do not cover our actual costs of providing care, and therefore we have recently had to make some difficult decisions that will impact the Arrowhead Family Medicine practice.

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Lake Wobegon was a place where “all the women are strong, all the men are good looking, and all the children are above average.”  We all recognize that Lake Wobegon is a quaint fiction; so why then do we act as if our doctors and hospitals come from a place where all are superhuman and there are no below-average doctors or hospitals?

A recent article in the WSJ highlights the benefits of using top-rated hospitals…that by making transparent the success rate of various procedures in Pennsylvania, companies that work with the best performing hospitals find significantly better outcomes for their employees…and save lots of money.

Although at times premium care can be exorbitant, there’s evidence some in Pennsylvania saved money using top-rated hospitals. Hershey Co. offered workers medical coverage based on the state agency’s reported outcomes, and cut the company’s expenses by 50% over several years. The Philadelphia police union’s benefits-management company says it uses the state reports to steer officers to the best hospitals; as a result, it say its costs fall about 17% below those of comparable plans.

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Was struck today that I have heard very little about the role of Medigap in the current health insurance debate…despite massive discussion of Medicare, Medicare Advantage, payment reform…etc.  In addition, it highlights how difficult it is to sort through the tangled web of money and influence…not sure how much I believe it, but its certainly food for thought.

This thought was triggered by Michelle Milkin’s post on AARP’s dependance on royalties from selling sponsored insurance plans:

A Hill source summed it up for me this way: “AARP has endorsed a huge reduction in funding of Medicare Advantage, which touches over 10 million middle-lower income seniors. If Medicare Advantage funding is reduced, and seniors are forced out of the program, they become potential buyers of the heavily-promoted and very profitable Medicare Supplement program sponsored by AARP (MediGap is 70% of AARP’s annual income). Medicare Supplement is a huge source of revenue to AARP. At a minimum, AARP should be required to disclose this every time they discuss Medicare Advantage.

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Sustainable health reform requires a solid foundation…unfortunately the proposals we’re seeing out of Washington create a more elaborate house of cards, as we continue to create an elaborate health care ponzi scheme.  The House that built Medicare has already saddled our country with Trillions in unfunded liabilities.  The proposals we see look to continue to reward a medical-industrial complex that creates and manages diseases rather than focusing on optimizing the health of people.

So what are the criteria of a sustainable health system? continue reading »

When I was a kid, I hit my head a fair bit, including getting knocked out once at football practice.  Initial care involved an evaluation, but scans weren’t the norm.  Now that they’ve become increasingly common in the evaluation of head injuries in youth, have we gained much?

The  Value of CT Scans in Youths Is Questioned in this study in the Lancet (article in NYTimes). continue reading »