Monday, May 24, 2010

P4P(Pay for performance) harmful effects may impact surgeons as well-I am shocked,shocked

This paper (see here) regarding P4P and its impact on surgery or the lack of it for the obese patient has received at least two appropriate commentaries in the medical blog world. DrRick (see here) and Robert Centor (see here)have highlighted the article pointing out yet another example of the unintended consequences of P4P.

The main point is that if surgeons or the institutions in which they practice are penalized for certain surgical complications or length of stay in the hospitals it is likely that when possible surgeons just might tend to avoid elective surgery in patients who are in a group likely to have a higher than average complications rate.Such a group is the obese.

Goodhart's Law which indicates that when a measure become a target it looses the characteristics that made it a valid measure is a valuable insight capable of explaining a lot of behavior. One of my favorite examples is the ill fated " four hour pneumonia rule.See here and here. Teaching to the test and treating the chart are phenomena in same general category.These things are so common and predictable that maybe we should not call the consequences unintentional. The planners ( at least some of them ) must have it figured out by now but just do not care.

Physicians have been criticizing the P4P nonsense for years now but the caravan moves on.Here are some comments I made in 2008 with reference to an excellent essay on the subject by the prolific Dr. Roy Poses.

Thursday, May 20, 2010

Medicare and Price controls -one more time

I harp on the theme of the effect of the price controls on physician's fees in regard to Medicare several times. It is good to see someone else playing that song. See here.

Price controls equals less and poorer quality medical care and PPACA , in part, through the agencies and panels it establishes will only make worse.

For another glimpse back into Economics 101, read this commentary by yet another articulate, thoughtful, EP cardiologist-blogger who talks about the decreasing supply of primary care docs and the soon to be ( well, by 2014) increase in demand for medical services plus the additional factor of more docs likely to be on salary and the likely incentives that will bring.Further, the increasing shortage of medical providers is not just in primary care.See here.

Tuesday, May 18, 2010

More on freedom to purchase one's own health care

See here for a interesting review of aspects of the history of health care insurance in the U.S. from Peter Zavislak at the blog Medical Pastiche. Note carefully what almost happened with Hillary Care .More detail on one important development in the history of US health insurance,namely the RBRVS, can be found on Doug Perednia's blog, The Road To Hellth, See here.

This is what Thomas Sowell had to say about what was being planned for America's health care by Hillary and friends in the update to his 1980 masterpiece, Knowledge and Decisions.

....[the]1993 attempt to have the government take over the entire medical sector of the country-an attempt spearheaded by people with neither medical training, hospital management experience,nor expertise in pharmaceutical research or even in the running of a drugstore.

Note what was contained in the Hillary care plan. Here are Zavislak's words on that:

Clinton Era – Attempted passage of Universal Health Insurance Plan Fails. IF it had passed, it would have been illegal to use one’s own private funds to pay for services NOT covered by this plan!!

This was a close call apparently largely averted by in fighting among Democratic party factions but this time we have a home run for those who believe that medical care is too important to be left to the individual physician and the individual patient that was made to happen by some folks with the same qualifications as described above by Sowell as well as some folks who actually went to medical school.

No, PPACA does not contain words that explicitly prohibit private transactions between physicians and patients ( as Hillary wanted) but see here for Dr. Richard Fogoros's presentation of his concerns about that possibility arising out of the recently passed health care reconstruction.

Sunday, May 16, 2010

Will Obama care lead companies to drop their health care plan?

An analysis published in Fortune ( see here ) makes a strong case for many employers to do just that."If you like your health care plan you can keep it"). Note to the leaders at AMA and ACP -can you say unintended consequences? On one of the other hands,could it be that the plan was to do that all along?

It seems to be a matter of doing the math. For example, the article says ATT now spends about 2.4 billion per year in health care costs and if they drop coverage and pay the penalties they will pay out 600 million.So if companies go that route, who pays for at least some of the cost of the shift to the exchanges.The government does in the form of subsidies which will invalidate the accuracy of the alleged savings from PPACA which has already been shown to be a bogus projection.

Did the brilliant planners in the administration and congress not see this coming or maybe that was the plan all along.Was the plan really to get employers out of the health care insurance business and move everyone over to the exchanges wherein insurance companies can be made to fail by the government setting the rates too low and and coverages too broad and then coming to the rescue with a single payer which is what Obama said he wanted all

Dr. Paul Hsieh makes the case here for a scenario in which the health care insurers tank and the government rides in and saves the day.

Friday, May 14, 2010

When you see how IPAB will cut costs, you will want to thank AMA and ACP for their roles in support of PPACA

Yes, the tittle is sarcastic. Go here to read a clear explanation of how exactly the Independent Payment Advisory Board (IPAB) will limit Medicare costs. In a nutshell, Medicare will reimburse physicians and other providers less. The bill is structured so that is about all it can do.

With more stringent price controls that IPAB will generate we will see an even more critical shortage of primary care physicians and a further decrease in quality of primary care. Did anyone at AMA or ACP read that part of the bill?

Another well recognized effect of wage-price controls is the development of a black market which we have not seen so far in health care but see here for how that might play out.

It gets even worse because the IPAB will also through administrative actions of the HHS secretary act to control the rise of private medical costs not just those controlled by CMS.See here.

H/T to John Goodman's blog ( see here ) which is a seemingly inexhaustible source of important information regarding health care economics and the effects we can expect from Obamacare.

Tuesday, May 04, 2010

Important series of blog posts on Individual prerogative to purchase health care

Earlier I had cited the first in a series of posts by DrRich of the Covert Rationing Blog concerning the issue of
of the future of the right of an individual to purchase his own health care. See here for the fourth and final post from which one can link to the first three.

In light of the numerous reassurances that PPACA is not a government take over and that one's access to medical care will not be limited it is enlightening to think back to 1965 and the Medicare law which clearly stated :

....that nothing in the new law “shall be construed to preclude [an individual] from purchasing or otherwise securing protection against the cost of any health services.”

DrRich then describes in detail the limitations contained with the Medicare system that already restrict private arrangements between Medicare patients and physicians who participate in Medicare.Understand this mean limitations on the individual to purchase certain medical test or treatments or procedures. I quote

... amendment to the Balanced Budget Act of 1997 - Section 4507 - which prohibited any self-pay contracts whatsoever between Medicare patients and their doctors for medical services which are covered under Medicare. Under Section 4507, which is still the law today, if a doctor provides even one self-pay medical service to a single Medicare patient, that doctor is punished by complete banishment from the Medicare program for at least two years.

The entire four part series is important and I urge followers of this blog to read it and take part in the discussion.