More than at any time in recent memory, powerful forces are buffeting
the health care sector. We are in
the midst of profound upheaval,
driven by market and policy responses to the industry's long-term
excesses.
We can already see evidence that the dysfunction of our traditional
health system is accelerating. It also seems clear that the center
cannot hold indefinitely.
Dog Eat Dog
It is useful to remember that the health care industry's
different stakeholders are adversaries. While they clearly share a
common understanding that a wholesale meltdown is possible, there is
little real motivation for collaboration and no unity. Independent of
role, the industry as a whole has been focused on, and extremely
effective at, securing dollars from purchasers: government, employers
and individuals. But each silo within the industry has been separately
focused on growing its own slice of the health care pie. In every
niche, there are courteous conceits – access, appropriateness, efficiency and value – reserved
for the good manners of public relations. But these are meaningful in
practice only if they do not conflict with the professional's or the
firm's economic performance.
Nudging the value glacier
By Sarah Arnquist
In just two years, seniors will spend a quarter of their monthly Social Security checks on Medicare out-of-pocket expenses, including premiums, co-payments and deductibles.Meanwhile, Medicare bookkeepers predict total health spending in the U.S. to increase from 2.2 trillion today to 4.3 trillion in 2017.
At that rate of growth, it won’t be long before the entire Social Security check goes toward medical care. So what’s the solution?
Barry Straube, CMS chief medical officer, said the solution is transforming Medicare into an active purchaser that seeks to get more bang — in terms of high quality care and improved health — for its buck.
In health care lingo, that’s called value-based purchasing – the topic of a two-day conference put on by the ECRI Institute that Straube,and other health care bigwigs attended this week in Washington D.C.
“Medicare should be paying for care that promotes health, prevents complications, optimizes quality and efficiency, and keeps health care costs down,” Straube said. “… We have a system that arguably is based on resource consumption and volume irrespective to the value associated with that care.”
The demands for robotic surgery
By Paul Levy
Many months ago,
I wrote about the da Vinci Robot Surgical System and expressed doubts
about whether there was evidence to support the clinical efficacy of
this equipment, as opposed to the marketing efficacy of the company
selling it. Well, the time has come to graciously say, “Uncle!”
Without
making any representations about the relative clinical value of this
robotic system versus manual laparoscopic surgery, I am writing to let
you know we have decided to buy one for our hospital.
Why? Well, in
simple terms, because virtually all the academic medical centers and
many community hospitals in the Boston area have bought one. Patients
who are otherwise loyal to our hospital and our doctors are
transferring their surgical treatments to other places.
Prospective
residents who are trying to decide where to have their surgical
training look upon our lack of the robot as a deficit in our education
program. Prospective physician recruits feel likewise. And, these
factors are now spreading beyond urology into the field of
gynecological surgery. So as a matter of good business planning,
concern for the quality of our training program, and to continue to
attract and retain the best possible doctors, the decision was made for
us.
So there you have it. This is an illustrative story of the health care system in which we operate
Paul Levy is the President and CEO of Beth Israel Deconess Medical
Center in Boston. He blogs about his
experiences at, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive.
Stanford Med School rejects industry funding for continuing education
Stanford University’s medical school announced this week new restrictions on educational contributions by drug and medical device companies, which turn out to be among the strictest in the nation.
The rules are an effort to limit industry influence on physician practice. Currently, the continuing education programs tend to follow the market’s needs and not necessarily the best advancements for optimal patient care.
"The school will no longer accept funds from pharmaceutical or device companies that are targeted to specific programs, as industry-directed
funding may compromise the integrity of these education programs for
practicing physicians," a press release states.
SiliconValley.com reported that "Drug and medical-device company
contributions for continuing medical education have surged nationwide
from $302 million in 1998 to $1.2 billion in 2006, according to the
Accreditation Council for Continuing Medical Education. Stanford
officials said about $1.87 million — or 38 percent — of the medical
school’s budget for continuing education came from industry sources in
fiscal 2006-07."
Ted Kennedy Shows Up to Vote; McCain Absent
When Ted Kennedy came onto the Senate floor, his colleagues cheered.
He was there to vote on the bill that would prevent a 10.6 percent cut to physicians who treat Medicare patients.
Just before Congress broke for the July 4 holiday, the bill missed the 60 votes needed to pass by just one vote.
Today, Kennedy, who is battling a brain tumor, brought that vote to the Senate floor. “Aye,” the 76-year-old Kennedy said, grinning and making a thumbs-up gesture as he registered his vote.
Meanwhile, it appeared that Republican members of the Senate had been released to vote as they wished after it became apparent that the 60-vote threshold would be met. Pressure from seniors, the AARP, and the AMA had been mounting on members who voted against the bill June 26.
NY Times examines CT scans and evidenced-based medicine
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
Think Again: Payments to doctors By Eric Novack
I am frankly a bit surprised at the lack of comment at THCB on the recent orthopedic device
manufacturers’ settlement with the government for concerns about illegal payments to physicians. I would have expected Matthew or Maggie, at least, to be sounding the alarm over the dangers of the private sector in healthcare. The most interesting byproduct of the settlement is the development of a public database where you can search by company to see who is getting the ‘big bucks’.
But like many simple statistics, the data can be misleading.
Let me be clear—paying a surgeon for ‘work’ with the real expectation that he or she will use a specific product is unethical, not to mention illegal (but a problem inherent in our 3rd party paymentsystem in medicine, but that is another issue entirely…).
One Phoenix area surgeon has been paid $3 million this year by Stryker.
‘Outrageous’, you say. “Ah- ha—see, all doctors are corrupt and need to be controlled”, others exclaim. But what are the facts? In this case, the surgeon helped develop some of the early hip and knee replacement designs… These designs have served as the basis for literally millions of replaced joints over the last 20 years. He owns a piece of the patent.Is it immoral to get paid for people using a product you work hard to develop? Should Google’s founders still benefit? How about those who own patents on everything vacuum cleaners to hair care products?
Of course they should– because our society encourages innovation by protecting the value of innovation.
