Wednesday, March 24, 2010

I Bet They Ain't Moving to Canada

ATLANTA, Georgia, March 19, 2010 ( - A new poll reveals that President Barack Obama’s health care reform may push as many as a third of the nation’s practicing doctors into shuttering their offices and getting out of the medical business entirely.

In other words, the doctor may not be in to see you shortly.

According to a survey conducted by The Medicus Firm, a nationally retained physician search firm, “nearly one-third of physicians responding to the survey indicated that they will want to leave medical practice after health reform is implemented.”

Sounds like a quick fix for bringing down the national spend. Would less doctors per capita be a good thing?

Dennis Cauchon, USA TODAY -Others worry that more physicians will drive up the cost of medical care, not make it cheaper and more accessible. Physicians will order more tests, more procedures and more drugs — without improving the nation's health, they say.

"Doctors create their own demand," says physician Don Detmer, co-chairman of an Institute of Medicine committee that, in 1996, recommended cuts in funding for medical residents. "If we produce an abundance of doctors, there's little incentive for the system to become more efficient." The Institute of Medicine is an independent group created by Congress for advice on medical issues.
Full story...

Monday, March 22, 2010

Field Trips are Fun! Random Op-Ed is Fun Too!

I received a link this morning to a cutesy video wherein Doctor Marshall advocates for Congress to come visit a hospital on a field trip and truly learn what's broken in health care. Obviously, a day late for me, but nonetheless it sparked a few thoughts which I've jotted down below.

Doctor John L. Marshall of Georgetown University is a very respected and highly regarded oncologist leading the charge against cancer. I'm sure the guy is a wonderful doctor, and has contributed enormously to his field.


I watched the video, and those of you with a Medscape login can too, it's here:

After watching it, I got just a tiny bit annoyed about how simplistically the argument was made with no actual proposals, solutions or advice given, just this grumbling about congress-doesnt-know-jack-about-my-problems rhetoric I've heard time and time again. So I decided to pick apart the arguments a little, my response after the jump.

1. About not having Congressional representation: DC has three electoral votes for Presidential elections, and a delegate in the House who can vote on House committees and many other procedures, just not on the floor of the House. DC of course has no-one in the Senate, because last time I checked DC was not a state that had ratified the Constitution. Just like Puerto Rico. If you want Senate votes, stop whining and become a state. Or rejoin Maryland. In the meantime, here's a record of Congresswoman Eleanor Norton's work as DC delegate including the bills she has introduced:

I also find it oddly contradictory that someone not overly-happy with government interference in his chosen profession then implies he wants more government in the form of diluting State's rights by giving votes to a federal district. Again, with no proposed solution or desire, just a complaint that he doesn't have representation.

2. About changing or picking a health insurance plan: Elected representatives are not born that way. While they have a decent health plan as members of the House or Senate, they (assumedly) had health care insurance *before* they were elected. His argument that all Congresspersons are ignorant of the ins and outs of acquiring health care insurance is misguided. Each of these people held jobs prior to holding office, and experienced the American life and system alongside everyone else. Many of them as self-employed professionals or small business owners.

3. About being on hold waiting for someone who doesn't know what you do day-to-day to judge your performance: I believe for an elected representative they are called "constituents" and "elections".

4. About being audited on their procedures and activities: Elected representatives are under constant scrutiny, myriad rules; are subject to ethics committees; are audited by the Government Accountability Office; furthermore they are then judged by hundreds of lobby groups who pore over each representative's and senator's voting record. The accountability of your average elected official in the federal government far exceeds that of a medical doctor, and comes with the added bonus of having to do a decent job to get re-elected.

5. About getting paid for good documentation:,,,, - I would like to see how fast this or any other oncologist can pull up records for a given patient he saw ten, twenty years ago. All other shortcomings aside, you can't possibly fault the government for it's record-keeping nor it's accessibility to same.

6. About pay-for-performance: (a) the federal government has *zero* pay-for-performance affecting doctors, there are a few pilots going on but no doctor in the USA is subject to pay-for-performance involuntarily and none at all from the feds. (b) Elected representative are very much paid by performance. Don't perform? Don't get re-elected. Doctors can lose their license and simply pick up and go practice in another state. Yay freedom. (c) The only thing the feds have done is told hospitals they, and by they I mean Medicare, will no longer pay for avoidable errors. Prior to the rule, a doctor could cut off the wrong leg, bill for it, then cut off the correct leg and bill for that too. Not anymore. Boo-hoo.

7. About being told what you as a doctor are allowed to do for your patient: No insurance company tells you what you are allowed to do. They tell you what you are allowed to bill for. Correction, you can bill for whatever you want, but an insurance company tells you what they will pay you for. The most current data on health insurance denials are 2.36 percent (AHIP) and 2.65 percent to 6.8 percent (AMA). AHIP has an interest in the number being low, AMA has an interest in the number being high, so cut that down the middle however you like.

Total denials for non-covered services were 1.2 percent. The number for denials in the raw is much higher, but much of this is simply billing the wrong insurer - which counts as a technical denial but some other insurer then gets the bill and pays up - or having to resubmit and getting paid the second time. Not perfect, but not denial of service either.

8. About Congress not having a clue what is wrong with health care: Congress has 16 doctors right now, plus two dentists, three nurses, a psychologist, an optometrist, a clinical dietician, and a pharmacist which by my math (25/535) is just under five percent of Congress. Seems to me the medical community is well represented in Congress.

The implication that the legislative branch of the United States federal government is tackling this problem with too little background, understanding and general knowledge of the problem is - in my not very humble opinion - a disservice to the viewers of the video. There is plenty wrong with Congress. And plenty wrong with hospitals. But the easy target of "the government is a bunch of morons" seems a particularly poor choice for such a learned gentleman.

9. About taking a field trip to a hospital to fully understand what's broken: Hospitals are not the universe of health care, an issue I see at way too many hospitals who forget they only account for under one third of health care in the USA. Hospital care is 31% of health care expenditures in the USA. Health insurance, of course, reaches all aspects of health care.

In summary: for sure, there are plenty of things wrong in all parts of health care, including hospitals. The notion that Congress should have taken some time to explore the issue before writing and passing legislation is of course, sound. Hmm. I wonder if any of them did? Do you think any of them ever spent time in side a hospital? Hmm.
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Wednesday, March 17, 2010

About Health Satisfaction Two Point Oh!

The past year has seen some leaps and bounds in the way me and my team can rapidly handle publicly reportable data and get it onto Web sites. The two underpinnings of this are CLAIRE, the Claire Lightweight Agile IPRO Reporting Environment; and Pellucid, the health care transparency database system. CLAIRE is a software framework built on CakePHP that allows the dev team to grab up Pellucid data and quickly deploy Web applications. Pellucid is a MySQL data warehouse we built to house every single publicly reportable value we know of or can calculate in house. More on both of these technologies later.

So last week I initiated a test. I gave the dev team a week to come up with a complete rewrite of our Hospital Satisfaction Web site, and lo and behold they did it! You can go visit and review patient surveys of nearly every hospital in the US! Why are you still here? Click the link already.Full story...

Thursday, March 11, 2010

Good Driver Discount

Seems to me the health insurance companies go on and on about how it should be more like auto insurance, everyone needs to be in the pool. I'm in favour, generally, although I wish it were a single-payer pool, but that aside... if we are all going to be in the pool, how about some good driver discounts? If I quit smoking, I don't get my premium lowered last time I checked. For auto insurance I can take a defensive driving course and knock 10% off the bill. How about reducing my premium for attending wellness sessions?

The difference between auto insurance and health insurance is that it's not a definite that you're going to have a car accident. You are most definitely going to get old and die. If you take good measures along the way to reduce your level of sickness, shouldn't you get a discount? Insurance companies wishing to adopt my proposal can do so free of charge, but I wouldn't mind a carton of cigarettes and a bottle of scotch as a nice thank you. INCENT ME!Full story...

Disclosures and Disclaimers


My employer is compensated through funding to provide analytical research, technology solutions, and Web-based public and private health care performance reports by the State of New York, the State of Illinois, the Centers for Medicare & Medicaid Services, the Agency for Healthcare Research and Quality, the Commonwealth Fund and Bridges to Excellence. I am not being compensated by any of these organisations to create articles for or make edits to this Web site or any other medium; and all posts authored by me are as an individual and do not represent my employer or the agencies I work for.