Physicians

PHYSICIANS: CYA Healthcare By Eric Novack

Dr. Eric Novack, THCB’s resident orthopedic surgeon and spokesphysician is an angry   man today. He is angry about people who go around blaming physicians for high healthcare costs. And he’s got something to say about it. What’s the real problem? Eric thinks its CYA healthcare. If you want to hear more from Eric, fire up your PC speakers and go have a listen to an archived webcast of one of his interviews on KKNT 960 AM radio in Phoenix.      

Thanks to all who participated in the ‘debunking’ of the “3% Myth” about Medicare’s efficiency. In other earlier posts, I have tried to address other great myths and misperceptions about the US healthcare system—see “an outcomes primer” and “association v. causation.” Another source of confusion and misperception is the statement that “doctors perform unnecessary tests and procedures simply for financial gain.”  Implied in this statement—and the basis for the ‘Stark Laws’ as well as single-payer proponents of government micromanagement of healthcare delivery—is that MOST physicians engage in this behavior MOST of the time, bilking patients and insurers, and substantially driving up healthcare costs.

I disagree. Before I get a wave of comments about how lab utilization decreased 25 years ago after Stark was introduced, read on. Did the introduction of Stark regulations (laws against self-referral for certain healthcare services) work?  Answer—NO.  If they did, why are we having the robust discussion here at THCB and throughout the country about healthcare?  Healthcare costs have continued, with few reprieves, to increase at faster than inflation rates for years.  The solution for the single-payer crowd—more regulation of providers and price fixing for service delivery.  It has not worked until now, and will not work into the future.

A much greater driver of costs today are patient-demanded healthcare and CYA healthcare.  It is difficult to quantify these costs, but the costs are huge.  Patients often come in ‘demanding’ an MRI or other test.  Accompanied with the demand is almost always the statement ‘well, I have insurance’, and ‘it is covered and will not cost me anything’.  These demanded test and procedures dovetail with CYA costs—fear of not getting a certain test and then discovering later a condition or problem needs treatment.  That ‘delay in diagnosis’ is one of the leading causes of medical liability claims.

The real culprit here, of course, is the 3rd party payer system that divorces patients from costs and risks—and places those risks squarely on the shoulders of healthcare providers.  Even for many of the chronically ill, the knowledge that someone else is picking up the tab alters behavior.

Changing the system so that 3rd party (insurance, government) payment is minimized will provide real market forces to reduce excessive healthcare costs.  Blaming doctors for the problem of ‘unnecessary’ healthcare, while failing to recognize the role of patients in driving costs is another area of distortion and misconception that clouds and confuses an intelligent discussion about healthcare.

Livongo’s Post Ad Banner 728*90

Categories: Physicians

Tagged as:

63
Leave a Reply

63 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
18 Comment authors
erronivorryharrumphMGPCBEric Novack Recent comment authors
newest oldest most voted
erronivorry
Guest

the boondocks adult swim <a href=http://reiieraiiver.freecities.com/adulta98.html>adult add treatment</a> <a href=http://markdot.freewebhosting360.com/adult271.html>adult hacked password</a>

Alex
Guest
Alex

Trial lawyer bashing can be fun and I like to engage in it from time to time, but IMHO part of the problem has been that the provider community is just so damn reluctant to change anything. Their medical societies write the statutes and they are policed by their own (or not) and the absence of any threat other than a lawsuit only makes the reluctance to change worse.

Peter
Guest
Peter
Barry Carol
Guest
Barry Carol

One especially nice thing the Board does is (through its Patient Care Assessment program) try to address systems-level causes of patient injury. Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston, recently made the following comment on his blog in response to a question from me: All of the hospitals in the Harvard system collectively own a captive insurance company that provides the Harvard hospitals with malpractice insurance. When it identifies problems or adverse trends, whether they are doctor specific, procedure specific, discipline specific or hospital specific, it brings the issue to the attention of the appropriate parties… Read more »

drthom
Guest
drthom

TLA talking points aside Matt (I’m still trying to figure out how 60 percent contingencies serve plaintiffs needs), the only reason this is a problem is in the context of a single payer system. If the physician is unable to adjust his income to make up for the vagarities of liability costs, which are admittedly a function of both risk and the overall insurance market, then those practitioners are going to flee the system. As care is universalized through a patchwork of inflexable mandates and government payors, there will come a point when fungible liabilty costs will hit up against… Read more »

harrumph
Guest
harrumph

Peter, why on earth would I want to defend the AMA? Where in any of my arguments is there any reference to judgment caps or other positions that sad, dying organization supports. I don’t even know if the AMA has a position on medical courts. If it does, it hasn’t received much publicity. I suppose I’ll just state the obvious: nobody (except maybe trial lawyers) is well served by errors in any setting–medmal or medical care. There’s no reason to believe that making the medmal system more accurate would harm patients. Regarding the replacement of juries, the point is not… Read more »

MG
Guest
MG

I get so sick and tired of hearing the physician lobby bark about the evils of the medical malpractice system and identifying it as the single-biggest problem in the US healthcare system. Yes, it is a problem, particularly in the some awards granted for “punitive” damages, but it represents an extremely tiny piece of overall healthcare spending. The fact is the that for most medical specialties, medical malpractice costs have remained flat or pretty constant as a percentage of practice revenues over the last 20 yrs. MGMA has some pretty good data on this although they don’t do out of… Read more »

PCB
Guest
PCB

Some serious heat coming off this thread. Good stuff. To add some additional information to the 2000 IOM report on the 44-98,000 error related deaths: 1. there was no appropriate comparison group (no “death rate” from comparatively sick hospitalized patients without errors to compare to the error group.) So how do we know what contribution errors made to the death rate in the group studied? 2. Because of #1 above, in order to make the 44-98,000 claim, you must assume that there would be NO DEATHS in a similar high risk “error free group.” This is clearly an unreasonable assumption… Read more »

Matt
Guest
Matt

“The trend is mostly driven by fear of litigation, and to a much lesser extent, a desire by some women to pick their delivery date.” Is that litigation fear rational, though? And if not, should we be making policy on the irrational fears of physicians? Do you not think convenience for physicians has anything to do with it? After all, during every malpractice “crisis” (we just ended the third one in 30 years), physicians have claimed that if we just give them this or that “reform”, defensive medicine will decrease and that all these expensive tests driving up the cost… Read more »

Peter
Guest
Peter

Barry, not sure this is what your looking for but here goes; http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=AR43_2004highlight_e “Among those who die of preventable errors, how many were very frail and near death and how many had their lives shortened by years? How many fewer deaths would there be if every hospital operated at the quality level of the best in the country?” I guess that from a simple view reducing errors reduces adverse outcomes to patients. Trying to figure out who would have died anyway or how many years the life was shortened are not really measurable, are they? Is that the point? Would… Read more »

Matt
Guest
Matt

Let me say this – I am certainly not arguing that the current system is perfect. It’s expensive and time consuming. However, given the value of time of the parties’ involved, particularly the physicians and attorneys, there’s probably no way for it not to be expensive and time consuming. No matter what system you use, both sides are still going to want their own experts. Both sides are still going to need representation. And the insurer is still going to want to keep its money and the patient will still need that money very badly. I just fail to see… Read more »

Barry Carol
Guest
Barry Carol

Peter, I wonder if you can provide any comparative data with respect to how our medical error rates and preventable deaths (especially in hospitals) compare to other countries on a per 100,000 of population basis. I have no idea. I’m also not sure what preventable deaths, especially in hospitals, consist of. I suppose they could include everything from botched surgeries to incorrect medications or dosages to central line infections to ventilator assisted pneumonia and who knows what else. Among those who die of preventable errors, how many were very frail and near death and how many had their lives shortened… Read more »

Matt
Guest
Matt

“You’re demanding high standards of evidence for some things (like the accuracy of patent courts…buddy, they’re just an example of an alternative to idiotic juries), micro-level details elsewhere (who pays the experts? give me a break…that gets worked out later), and making ridiculous assertions (doctors complaining about expert opinion? Which experts? Where? Do you have something other than anecdote to back this up?). ” Actually, I’m not demanding anything. I’m asking for the evidence to support someone’s claim that patent courts work so well and so much better than the jury system. I assume before that person reached that conclusion… Read more »

Matt
Guest
Matt

“What I’m saying is simple: Juries should be made up of qualified people, not housewives that fall for crying defendants. Not O.J. jurists.” Who gets to decide competence? You? I think this is along the lines about how everyone views their position on issues as the “reasonable” one. Well, obviously that can’t be the case for all. “I am not an expert on other countries (nor anything else, for that matter), but it seems to me that Britain has a pretty decent system. But I’ll let others comment on that.” What about it is so much better? If you’re going… Read more »

Peter
Guest
Peter

“Goodness gracious. I suppose we can’t simultaneously try to work on two flawed systems at once.”
harrumph, please tell me how much lobbying, time, and persuasion money is spent by the AMA on the issues I listed above as opposed to doctor financial issues like tort protection? Maybe I would have a better idea of how the AMA is advocating for patients as well.