Matthew Holt

Another nail in the DM coffin?

Just when you thought it was safe to go back to the water, the CBO is out with the bad news that in its analysis of over 30 disease management programs, and none of the independently run ones saved Medicare any money. Even the ones that succeeded, which put the medical groups at risk and generally lodged the DM nurses with them (rather than have them call in on the phone), didn’t save enough to justify the costs of the program.

Now the first group isn’t a surprise to those of us who followed the fate of Medicare Health Support. The second group includes a series of demonstrations paying physician groups to save money. They did better, but not well enough to save once the extra costs of the program are included. (Details here). We can only hope that using more lightweight technologies with better understanding of patient behavior does in fact end up saving money–as has been shown in some commercial medical home settings. But we must also be prepared to admit that we don’t yet know how to save money in the care of the chronically ill under Medicare. Which means that the only obvious way to do it is to cut payments to providers!

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Huxley Miller, M.D.MD as HELLRebecca Coelius Recent comment authors
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Huxley Miller, M.D.
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Huxley Miller, M.D.

As a practicing internist, I wonder if we could spin these results another way. Thirty well funded attempts at reducing cost and improving care via disease management, care coordination, and value based pavement failed to show improvement compared to the control group. And what was this control group? It was this nation’s beleaguered doctors who put in long hours every day trying to do the best we can as efficiently as we can. Perhaps our care is not so deficient after all.

MD as HELL
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MD as HELL

You save money by telling beneficiaries to listen closely as the menu has changed.

No more dialysis for the nearly dead. No home health to give baths and feed you.

No more feeding tubes for anyone on Medicare.

No visits to the hospital from the nursing home.

No dialysis for cocaine addicts (and no disability, either.)

It is really easy if you really want to solve the problem.

Rebecca Coelius
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Rebecca Coelius

How long was the intervention, and how far out did they track outcomes?

The very nature of chronic disease makes these vital questions.