Author Archives

Matthew Holt

The Feds’ strange love-hate relationship with health IT policy

Jul 1, 2008• 5

By David Kibbe

With less than loud fanfare — barely a peep, really — the Office of the National Coordinator for Health IT (ONC) finally last week released its ONC-Coordinated Federal Health Information Technology Strategic Plan.

The plan is more than two years overdue and came only after scolding from a Government Accountability Office report in 2006 and an internal, semi-secret review of ONC’s doings by the Institute of Medicine late in 2007. The IOM criticized ONC for the lack of a viable strategic road map almost four years after President Bush’s call for interoperable health information technology and personal health records. A lot has happened since 2004 in this area, though you’d hardly know it reading the ONC Plan.

ONC is a top-down, heavily bureaucratic,
large-medical-enterprise-centric, and large-IT-vendor-led juggernaut
that has always been out of touch with what goes on down on the ground
where consumers, patients, nurses, and primary care doctors live and
work.

Using virtual reasoning to redefine health care

Jul 1, 2008• 2

By Marlene Beggelman

Dr. Marlene Beggelman is the CEO of Enhanced Medical Decisions, which is the company behind DoubleCheckMD.com.

The Internet is redefining the health care industry. Major transformations can be expected because Internet-based technology will deliver certain health care services more effectively and at lower costs. In the near future, much of the information that is currently imparted to consumers by clinicians will be delivered through and by web-based technology. If the web-based tools that deliver this information mature to the point of becoming reimbursable, beyond their current usefulness as value add-ons, the health care industry could experience a dramatic shift.

Today’s news today, doctors, Peel, and individual insurance

Jun 30, 2008• 4

By Matthew Holt

I just noticed that THCB today is all about last week and Sunday’s news—including Merrill Goozner and me jumping separately on the same magic quote in the NY Times CT piece. So how about three little pieces of news about stuff reported today.

First off, in a desperate attempt to keep the Republicans from losing all 33 Senate seats in November, CMS is freezing the cuts in Medicare fees which were due to go automatically into effect this week. Bob Laszewski has a just excellent explanation of how the Dems finally seem to have figured out how to play hardball with the Republicans and AHIP. Perhaps they’ve taken on Tom Delay as an advisor, now he’s not so busy. Meanwhile Bob thinks that the 7 missing Republican votes will return from July 4 and the Medicare Advantage and PFFS plans will get their comeuppance. Wall Street isn’t so sure, and those health plan stocks are trading higher today.

A classic from a cardiologist

Jun 30, 2008• 5

By Matthew Holt

The NY Times has a long piece on the fast spread of 64 slice CT scans and their using in cardiac imaging. This is all pretty much taken straight from Shannon Brownlee’s fabulous book Overtreated which has a whole chapter on the topic. But it’s good to get the debate out there.

It appears that essentially there’s no real reason to use these scanners for the vast majority of patients. And in fact they’re use probably leads to more unnecessary angioplasties and stenting (which in itself doesn’t seem to reduce the number of heart attacks). But of course once a practice buys a 64 slice CT it’s an ATM machine sitting in the corner—not much good if you don’t use it, but very profitable if you do. Of course, the more conservative approach gets short shrift and those waiting for evidence to justify all this spending get ignored in the rush by both doctors, hospitals and manufacturers to get at the taxpayer’s coffers.

I was though vastly amused by this quote from an Manhattan cardiologist which will bring joy to the ears of those fuddy-duddies in the pay for performance movement:

Cardiologists like Dr. Brindis hurt their patients by being overly conservative and setting unrealistic standards for the use of new technology, Dr. Hecht said. “It’s incumbent on the community to dispense with the need for evidence-based medicine,” he said. “Thousands of people are dying unnecessarily.”

Of course he just knows that thousands are dying due to lack of these scans, so why do we need any evidence!

Run for the hills: the doctors are coming

Jun 30, 2008• 5

By Robert Laszewski

What is the one thing no human being should want to be next week?

A Republican Senator at a Fourth of July Picnic.

In the most amazing turn of events I have seen in 20 years of following health care policy in Washington, the Democrats have the Republicans backed into an awful corner over the issue of the July 1st automatic 10.6% Medicare physician fee cut and corresponding private Medicare cuts to pay for nixing it. Also at stake is another 5% physician fee cut set for January 1, 2009.

Doctor fee stalemate exemplifies problems of universal health care

Jun 30, 2008• 13

By Donald Johnson

The thousands of physicians and millions of Medicare beneficiaries who think the government should provide “universal health care” insurance to all Americans are getting a good look at how ugly such a politically-driven scheme would be. Doctors would see their incomes fall, and patients would suffer big time.

Because Congress cannot agree on how to prevent a 10.6 percent cut in Medicare payments, doctors are threatening to drop their Medicare patients. And because the Democrats want to prevent the cut in Medicare payments to doctors by cutting payments to private insurers that cover millions of Medicare beneficiaries, insurers are threatening to drop out of that program and make those Medicare beneficiaries very unhappy.

The Washington Post’s report on the politically-driven stalemate is here. Clearly, the Democrats are intent on winning political points regardless of what happens to patients. And the Republicans are intent on preserving Medicare Advantage, which they created when they controlled Congress.

Under a “universal health insurance system,” which is advocated by the Democrats, political fights like this would happen every year. Doctors and insurers, if they were still in business, would face payment cuts. Patients would face uncertainty about who their doctors and insurers would be. And relationships between doctors, insurers and patients would become more strained than some of them already are.

NY Times examines CT scans and evidenced-based medicine

Jun 30, 2008• 5

By Merrill Goozner

The front page of the New York Times Sunday morning had a don’t miss article on the financial incentives behind using CT scans to look for heart disease. Medicare’s decided in March to begin paying for the test despite no evidence that it saves lives (see this GoozNews post). The lobbying campaign by a newly created physicians guild that invests in CT scanning clinics is discussed in the last few paragraphs of the story. That campaign was aided by "entrepreneurial guidelines" touting the procedure, discussed in this GoozNews post.

Here are the two key quotes from the story:

"It’s incumbent on the community to dispense with the need for evidence-based medicine." –Dr. Harvey Hecht, Manhattan cardiologist and CT scan advocate

"There are a lot of technologies, services and treatments that have not been unequivocally shown to improve health outcomes in a definitive manner."–Dr. Barry Straube, chief medical officer, Medicare

Drug advertisements annoying and possibly misleading

Jun 30, 2008• 9

By Sean Neill

Sean Neill is a South African-born, British-trained anesthesiologist, who
recently relocated to Midwestern USA. He blogs regularly at OnMedica about his cross-cultural experience, frequently pointing out oddities of American health care.

Watching television in America takes some getting used to. Apart from the accent, it is strange to hear companies marketing drugs directly to the consumer. Not only do they sell their own brand, but they actively name and shame their competitors’ products. During a commercial break there may be two different brands of antihistamine telling you how bad the other is.

Direct-to-consumer advertising (DTCA) is the promotion of prescription drugs through newspaper, magazine, television and internet marketing. Although the drug industry is mounting major campaigns to have DTCA allowed in Europe and Canada, the only two developed countries where it is currently legal are the U.S. and New Zealand.

Studies have shown that increases in DTCA have contributed to overall
increases in spending on both the advertised drug itself and on other
drugs that treat the same conditions. For example, one study of 64
drugs found a median increase in sales of $2.20 for every $1 spent on
DTCA. It has been reported that 10 of the leading 12 brand-name drugs
with DTCA campaigns have sales in excess of $1 billion annually.

Should Progressive Reformers Talk About Reining in the Cost of Care?

Jun 27, 2008• 14

By MAGGIE MAHAR

“It seems that John McCain may have stolen some of the fire that Democrats traditionally wield on health issues by making cost control his top priority, rather than universal coverage.” -Rob Cunningham, “Health Affairs” May/June 2008

Last week, the bold proposal for health care reform that Dr. Ezekiel Emanuel outlines in Healthcare, Guaranteed drew high praise from the American Prospect’s Ezra Klein. As Klein described it:

Emanuel’s Guaranteed Health Care Access Plan maps out “a total transformation of the system. It does not build on the inefficiencies of the current structure, preserving them in amber for the next generation.”

Rather than expanding on the dysfunctional system that we have today, Emanuel, who is the director of bioethics at NIH (and brother to politician Rahm Emanuel), is calling for structural reform. This is what makes his proposal both brave and fresh.

But Emanuel’s plan isn’t just exciting; it’s practical. As usual, Klein cuts to the heart of the matter: “The big deal, he explains is cost control. In health care, cost control is everything.”

The mutli-factorial equation of individual insurance

Jun 27, 2008• 3

By Matthew Holt

I’m up at Spot-on talking about the perils of being in the individual insurance market and wondering whether I should get out. As ever, come back here to comment if you please.

I want to ask your help. I have to make a financial decision
regarding my health insurance and given the confusion of the system –
one I’m supposedly expert in – I need advice.

Now realistically you’re not likely to be much good to me. Why do I say this? Well, the data says you’re dummies.

Last week Trizetto, a private tech company, put out a survey that said as much. While 80% of consumers surveyed were concerned about health care costs, less than a third knew how much their family spent.

It gets worse. Around 60% of Americans, including the vast majority
of those under 65, get their insurance from their employer. How much
are employers paying each year? Well according to Joe Public, not that
much. Most don’t know, or they think it’s less than $5,000 per family. In
reality it’s around $9,000.

But I’m not one of the blissfully ignorant who gets his
insurance at the company trough. Well, not quite. And hence my cry for
help. Read the rest