It’s become one of those trendy phrases, “unnecessary care.” When you hear it on television or talkshow radio it’s usually said with a sneer. Indeed, the speakers almost spit the phrase out — “unnecessary care” — like it tastes bad. It’s almost always accompanied by “fraud and abuse,” or a not so subtle accusation that some doctor is profiting off this unnecessary care at the expense of some poor …
What exactly is unnecessary care?
As Occupy Wall Street has gone from an obscure protest covered only on blogs and social media to a national phenomenon, the apparent parallels between the issues it is raising and the issues we have been raising in health care grows.
A growing number of protesters are calling themselves the “99 Percenters,” referring to those who are not in the top 1% of earners. The top 1% of income is clearly greater than $250,000 per year, and likely …
Why 99 percent of health care should be angry
With all the debate about cost control, it’s clear that we doctors will have to police ourselves – or else politicians and insurance companies will exert even more influence over our practices than they already do. The main question is:
Are we willing to let our physician colleagues exert influence on our care decisions?
Taking a case from my field: at a conference this past week I met a radiology resident …
Our easy access to imaging has led to overutilization
Why does health care cost so much more in the United States than in other countries? The answer is exceedingly complex; pharmaceuticals, hospitals, and physician services (among others) comprise the multiple slices of the health care pie that in the United States is about twice the size of the next largest spender for health care services.
A new study from one of President Obama’s appointees (note: this study was written prior …
Are physician services to blame for high health costs?
The relationship between doctors and their patients has changed dramatically over the past few years. Medical beneficence became paternalism and is now near obsolete. Shared decision making is the new lofty ideal we should all be striving for. It is guiding new health policy both in the UK, with the new mantra “nothing about me without me,” and in the US.
We are at the start of the Century of the …
Shared decision making is impossible in a government run health system
Data from the Dartmouth Atlas show patients with chronic illness in their last two years of life account for about 32 percent of total Medicare spending, with much of that expense going toward physician and hospital fees associated with repeated hospitalizations.
Opportunities to reduce medical expenditures during the last 2 years of life are often looked upon as a way to reduce the cost of healthcare while actually improving the …
Palliative care physicians can enhance patient decision making
After nearing the brink of political collapse, Congress and the President reached agreement on a plan for deficit reduction. Part of the agreement is that a “super committee”will cut an additional $1.5 trillion from the federal budget. Cuts are being considered for a range of programs, including Medicare. As director of a wellness program for retirees, however, I remain acutely concerned about the impact Medicare cuts will have on …
Physicians need to be part of the overall wellness process
My hospital, UCSF Medical Center, is thriving. Our profits this year will be nearly $200 million. We’re building a sparkling clinical complex – a combined women’s, children’s, and cancer hospital – adjacent to our new downtown biomedical research campus.
We are installing a state-of-the-art computer system. US News & World Report calls us the 7th best hospital in the country. Our students, residents, and fellows have never been better.
Yet angst is in the air, borne …
The threats to profit in academic medical centers
What’s the most effective way to predict which patients will be hospitalized in the coming year? The Heritage Provider Network, a managed care group in California, hopes to answer this question through its sponsorship of the Heritage Health Prize, a $3 million X Prize-like competition for health care. The contest invites participants to develop a prediction algorithm to identify patients who will spend time in the hospital in …
How to predict which patients will be hospitalized
Boondoggle – a scheme that wastes time and money. Perhaps this is not the best way to describe the many efforts that are being made to try to keep patients with non-urgent problems from using the emergency department, but from where I sit, deferral of ED care is a cost-saving tactic that not only fails to deliver much in the way of cost savings, it also is a strategy that …
Why deferral of emergency care is risky and unethical
Rationing is defined as the controlled distribution of scarce resources, goods, or services. In health care, rationing is not a new concept and has been occurring for years, most often in times of emergency but also when resources are merely limited or demand is greater. For example, an increased need for ventilators in the winter months during flu epidemics; organ transplants are dictated by the availability, or the shortage, …
In health care, rationing is not a new concept
The New York Times recently ran an op-ed by Paul Krugman with the intriguing title, “Patients Are Not Consumers.”
Here’s an open letter to him:
Dear Dr. Krugman,
As a comparative effectiveness researcher, I agree with many of the arguments that you are making in your most recent article. However, I disagree with your main point that patients are not consumers.
I understand your sentiment and agree that patients are more …
Patients need help to navigate the health care system
There has been a significant outcry against the proposed ACO regulations: everything’s wrong and nothing’s right about them, or so some would have us believe.
Today’s “nattering nabobs of negativism” focus on: the estimated price tag for complying with the regulatory requirements (IT and other infrastructure included), the slim chance of success by ACOs in righting the wrongs of decades of bloat in the health care system, the …
Why an ACO is essentially an American product
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“Doctors, with the consent of their patients, should be free to provide whatever care they agree is appropriate. But when the procedure arising from that judgment, however well intentioned, is not supported by evidence, the nation’s taxpayers should have no obligation to pay for it.”
So argues Dr. Rita Redberg, a cardiologist and professor of medicine at the University of California, in a provocative op-ed published in the New …
Should Medicare pay for procedures that have no proven benefit?
An excerpt from Balancing The Budget is a Progressive Priority.
It is our cultural fear of death and inability to discuss the limits of medicine to forestall death that enables the politics of health reform to be so potent.
When I did a post-doctoral fellowship in England in the mid-1990s, a professor I met who had lived in the U.S. explained to me why he thought health policy discussions in that nation …
The root cause of why our health system is unsustainable
Major journals have slipped in another article that apparently was designed for controversy and for widespread distribution to media outlets. The New York Times rapidly picked it up. As the nation enters the final months before 29.5% fee cuts for Medicare physician services, there will be many more of these that reach the light of day – too many if this is an indication.
What is common to major journals, media …
Primary care gets caught in the physician pay crossfire
The realization that the American health care system must simultaneously decrease per-capita cost and increase quality has created the opportunity for the United States to learn from low and middle-income countries. “Reverse innovation” describes the process whereby an inexpensive innovation is used first in countries with limited infrastructure and resources and then spreads to industrialized nations like the United States.
The traditional model of innovation has involved the creation of …
United States health care may need reverse innovation
A guest column by the American Medical Association, exclusive to KevinMD.com.
Every year since 2001 the threat of severe physician payment cuts, imposed by Medicare’s failed sustainable growth rate formula (SGR), have jeopardized the stability of the Medicare system and compromised access to care for patients. And every year – sometimes several times a year – Congress has put in place short-term …
AMA: A new opportunity to fix the SGR
The current reorganization of health care could make it better and cheaper for everyone, harnessing real creative and competitive energies to build the “next health care” —or it could lead to local monopolies, higher prices and less real competition where it matters. The many and various moves toward accountability, competition and transparency could defeat themselves.
The theme of the reorganization is clear: new types of cooperation between physicians, hospitals and other …
How health reform is reshaping health care markets
A guest column by the American College of Physicians, exclusive to KevinMD.com.
In April 2011 I finished seven years on the Board of Regents of the American College of Physicians (ACP) including two years as Chair of the ACP Health and Public Policy Committee and serving during the last year as President. During that time I had the opportunity to …
ACP: Current and future payment and practice trends in medicine
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