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OFF-TOPIC: Here’s your feel good story for Christmas

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A clerk working at Sees Candy lost her ring — a diamond encrusted family heirloom — thinking she’d let it slip into a bag of candy. There’s quite a bit of fuss in the Bay Area media about it, with appeals and all that, but realistically you’ve got to think it’s gone, right?

Yesterday a shopper was about to throw out their bag that they’d bought from See’s and in the bottom is the diamond ring. There’s even a reward that the shopper wants to be given to charity….

I’m tearing up. I may just have to watch “It’s a Wonderful Life” tonight…

 

PHYSICIANS/POLICY/POLITICS: Is cutting Medicare Part B fees a good thing? by Eric Novack

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THCB’s favorite orthopedic surgeon Eric Novack is grumpy about Medicare’s proposed cuts in physician reimbursement, which are still up in the air as I write. Not sure how much support he’ll get over here on THCB, but it’s ironic that $10 billion is being set aside for health plans and PBMs to reimburse them for possible losses for their role in Medicare Part D, and hospitals are getting a raise. If we are going to cut Medicare, wouldn’t an across the board cut be fairer? Here’s Eric’s thoughts:
Unless Congress acts in the next week, reimbursement to physicians for services provided to Medicare recipients will be cut by 4.4%. The government’s formula for determining the payment rate does not take into account the increasing costs of healthcare delivery. Rather it is based upon such factors as the cost of prescription drugs and general economic factors over which doctors have no control. The reduction is not merely a reduction in the rate of growth of spending. Payments of $100 will become $95.50. And if the Congress’s inaction continues, payment will be less than $75 by 2011. No adjustments for inflation or cost of living are included.
Is all Medicare spending being cut? No, only payments for outpatient services- Medicare Part B- are affected.
Hospital care, paid under Medicare Part A, will get a pay increase of about 4.8%. Managed care plans that get paid by Medicare for managing Medicare HMOs will also get a raise. In both cases, the government’s formula for payment is based upon the medical economic index, which takes into account the costs of health care delivery.
Other than doctors, why should anyone care that reimbursement is going down? What options do patients and physicians have? Doesn’t more affordable mean more accessible?
Nearly 97% of US doctors participate in Medicare. This means that the doctor has signed a contract to accept the rates that the government says it is willing to pay for services. Doctors cannot be selective. They must accept the rate for any and all services that Medicare offers. They cannot tell patients that they will accept the contracted rate for one service, but not another. For example, doctors are not allowed to accept the Medicare rate for knee replacements, but not for hip replacements. This is especially an issue when it comes to the care of very complex conditions, as the level of expertise, time necessary, and potential liability is significantly increased, whereas payment is often only minimally higher than for the care of much simpler cases.
Physicians have several ways to deal with the Medicare cuts. They can retire and stop practicing medicine. Some will. They can see more patients each day, spending less time with each patient. Some will. They can stop practicing medicine and pursue other careers. Some will. They can limit the number of new Medicare patients they will see. Some will. They can drop out of Medicare altogether, requiring Medicare patients to pay completely out of pocket for healthcare services. Some will.
Patients have few, if any, options under the current structure of Medicare. Seniors cannot opt out of Medicare and find private insurance to cover care.
Government fixing of healthcare prices below reasonable market rates will create the medical equivalent of the gasoline crisis of a generation ago. The planned and projected Medicare cuts will have exactly the opposite of the intended effect: seniors throughout the United States will have less access to doctors and healthcare services.

TECH: JSK’s 2006 Health IT Forecast

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Skip over to iHealthbeat to see the ever wonderful Jane Sarasohn Kahn’s 2006 Health IT Forecast

Jane is pretty gung-ho about ePrescribing. She says:

I predict that e-Prescribing will come of age in 2006. With Medicare kicking the tires on e-prescribing standards, we’ll see adoption of eRx on a selective basis. An innovative handful of health plans will foster adoption by providing incentives to prescribers in regional marketplaces. By the end of 2006, e-prescribing will reach a tipping point, and it will take off in 2007 because of Medicare’s push for adoption.

It’s not secret that we share this view — after all we spent last year writing a study about it that will be out shortly! this is one of the times when Morrison’s corollary to Herb Stein’s law comes into play. Stein said that “if something is unsustainable in the long run, it will end”. Morrison riffed on that to say, “If it’s going to be a big deal eventually, it’s got to start somewhere”.  We think that the next 18 months is the “starting somewhere” period for eRx. I hope that we’re not being too optimistic!

Jane is however a little too polite about RHIOs. Ann Donovan from the California RHIO told me last week that the CEOs of the big players in Claifornia were sending people to their meetings but the people showing up didn’t know why they were there. Reading between Jane’s lines this looks like CHINS all over again. The first report we wrote together in 1994 was also about CHINs, and we said there that they might end up as a sideshow, and again we were being too optimistic!

BLOGS/POLICY: My readers are way smarter than I am

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The best thing about this year in THCB has been opening the comments up for discussion, which was actually a function of changing hosts from Blogger to TypePad, and not part of some grand design. Although certain themes have been overly repeated (and you know who you are, Ron), the overall quality of the discussion in the comments has been excellent, especially in last weeks EMR discussion, and in yesterday’s responses to what was really a throwaway piece about the tax-deductability of health care benefits. Having spoken to several of my regular commenters, and having had email back chats with many more, I can only say how impressed I am. Take a look at both of those threads and see the variety of high level discussion, arguments and counter arguments.

I am only saddened by the fact that this type of discourse (the intelligence rather that the civility of it) is so far way from being typical in American political life. That’s why in my own small way by starting a column over at the political site Spot-On I’m trying to, so to speak, bring it to the masses. But long may THCB stay a place where the smart health care wonks can thrash out the big issues.

TECH: Interesting post on physician IT education

Tech-over-achiever Shahid Shah’s new IT aggregator blog — the HITSphere— has started up a community feature that’s well worth tracking. Several people have started their own blogs there and one is an MD called Mike. He has some interesting things to say about how to get doctors to the point that they can “learn to love the EMR”. His piece is called: Healthcare IT, Informatics and GME: Are We Doing Enough? Go take a look but here’s a flavor.

If we teach our future physicians the basics and give them the tools to self-teach in the future, they will be better equipped to adapt, optimize and lead. Future challenges related to standards/inter-operability, languages and security should not be left entirely to non-physicians. We as a group want functional cost-effective solutions and so we should be willing to invest in that future by training leaders to help guide us.

TECH/CONSUMERS: Joe Paduda is nice to Steve Case

Here’s Joe Paduda on Steve Case’s strategy for Revolution Health

Loyal readers know I have been less than impressed with Case’s strategy, team, and acquisitions to date. While I admire the audacity, I question the judgment.

Joe is too nice.

It’s all very well Case going to talk to Warren Buffet about this. The guy he should have talked to was Jim Clark who said exactly the same things as Case is saying now in 1995 before he started HealthEon. Luckily for Clark the stock market insanity enabled HealthEon to buy up some real companies with their valuable paper despite the fact the company had basically no revenue and no products that seemed to actually work. Amazingly enough they didn’t completely kill their acquisitions in the process—although it was a damn close run thing. Case tried the same thing with Time Warner when AOL bought it….and it survived but as a very wounded beast.

Still if he wants to piss away his $250m or whatever, it’s up to him. But perhaps he should talk to someone who knows something about health care first.

However, if he really wants to change the system he’d have been better off taking either Bill Gates’ approach or trying to agitate for a political solution like Philippe Villers did with Families USA.

QUALITY: Can a hospital CEO get us all to integrate (medicine, that is…)

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This is pretty interesting. A fairly hard nosed hospital CEO, under it appears the tutelage of his new wife, gets into alternate and preventative medicine. 

Three years ago, Treuman Katz got some troubling news: At 60, he was on his way to becoming a diabetic. Katz, CEO of Children’s Hospital & Regional Medical Center at the time, could have relied on the region’s top specialists. Instead, the man who had spent nearly 40 years running two of the country’s pre-eminent hospitals reached out to a naturopathic doctor. He took herbal supplements, changed his diet, started yoga and hired a naturopathic trainer. Soon, his blood sugar dropped and he began to feel healthier than he had in years, he said.

Fair enough. But then he tries to integrate it with the care his institution delivers.

That opportunity came five years ago, when Katz and his medical staff
started to notice an intriguing trend: More than half of their patients
were using natural medicine but not telling their doctors. Therapies
ranged from herbal supplements to acupuncture.

So Katz organized a small group of physicians to visit Bastyr to
start connecting NDs — naturopathic doctors — and MDs, Molteni said.Brown-bag lunches with Bastyr naturopaths followed. The hospital put
together a group to study how herbs could affect drugs. It hired two
anesthesiologists/acupuncturists and will work with Bastyr to bring on
a chiropractor, a naturopathic doctor and a traditional
Chinese-medicine practitioner within the next year or two.

I live in a city with more than 70 yoga studios and probably more than 300 acupuncturists, so there is something going on in the alternate care movement that deserves some level of integration with tradition western care. This might be one approach that makes sense.

BLOGS: Grand Rounds up at Medpundit, and here next week

Whoops. If you’re looking for the December 28th, Grand Rounds please click HERE.

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Grand Rounds is up at the ever-wonderful Medpundit’s site. OK I rag on Syd a lot, but she’s a great blogger in addition to having a real job. I just wish that her no-nonsense views on medicine transfered over to her views on politics, but I’d be happy to have her as my physician (but no, I’m not moving to Ohio!)

Meanwhile, next week Grand Rounds will be here at THCB. It’s a best of the YEAR 2005 edition, so send me you favorite post from the year. Email to matthewATmatthewholtDOTnet

 

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