Correctly Controlling Care Costs (Series)
Submitted by Dr. JG Kaplan on Thu, 2010-01-07 22:11
The Cost of Care --the Elephant in the room
A mini-series that exposes the fundamentals of reform, largely missed in the current debate.
First, see Paul Krugman's "Patients Are Not Consumers."
"The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car. [But,] 'Consumer-based' medicine has been a bust everywhere it has been tried....there’s something terribly wrong with the whole notion of patients as 'consumers' and health care as simply a financial transaction."
"Medical care, after all, is an area in which crucial decisions — life and death decisions — must be made. Yet making such decisions intelligently requires a vast amount of specialized knowledge. Furthermore, those decisions often must be made under conditions in which the patient is incapacitated, under severe stress, or needs action immediately, with no time for discussion, let alone comparison shopping."
Then David Malakoff's "Can Treatment Costs Be Tamed?"
Over the past 3 decades, total U.S. spending on cancer care has more than quadrupled, reaching $125 billion last year, or 5% of the nation's medical bill, according to a recent estimate. By 2020, it could grow by as much as 66%, to $207 billion. Multiple forces are driving the spiral: a growing and aging population, more people living longer with cancer, and new "personalized," or "targeted," therapies that can come with sticker-shock prices of $50,000 or more per patient. New and more costly, however, haven't necessarily meant better. Although targeted treatments have helped improve survival rates for many cancers, some extend life for just a few weeks or months (see p. 1542). And the prices can be sobering: more than $1.2 million to extend a lung cancer patient's life for 1 year in one scenario involving a costly but common drug. That example is unusual, but such numbers have sparked a growing—and sometimes feisty—debate over how best to calculate the benefits of new cancer treatments, whether their use will lower or raise per-patient expenses, and who should decide whether using them is worth the cost.
Read the Full Text [free registration required]
The column I just finished in LinkedIn MCO Managed Care Executives forum generated about 600 comments' the current one is approaching 200. Here's a recent comment. I placed there after a heated debate:
No, unit prices are not off limits, but simply placing caps ignores legitimate advances, denigrates the role of the advocate in extenuating circumstances and cuts off my legs as a practitioner. (And, Yes! there is waste in the system--I see it every day in practice--ordering meds after arguing with the insurer, not getting paid to remove stitches put in at the ER, not getting paid for my costs with vaccines, nebulizer treatments, call backs, after hours work, sensible follow-ups and referrals, when appropriate, etc.)
Just reduce doctors salaries or rather earnings? Consider this recent NY Times Letter to the Editor:'
"While there is little doubt that the end of the “Marcus Welby' era of family medicine is of concern, the acute shortage of family physicians being produced by our nation’s medical schools is even more worrisome. At Tufts University School of Medicine, for example, students graduate with a median debt of over $250,000, and despite a highly rated, mandatory six-week clerkship in family medicine, very few students choose this as a career.
Possible solutions being developed revolve mainly around transforming the work life of family doctors and significantly increasing their compensation. The urgency of this problem cannot be overstated.
Consider the consequences of failure: without a personal physician, the 64-year-old woman who called the doctor profiled in your article about heart palpitations and a bad headache would have surely wound up in an emergency room with the same outcome at 10 times the cost.
Multiply that by the enormous influx of baby boomers into our health care system in the next decade and you begin to understand the medical and economic disaster that might await us."
ROBERT L. DICKMAN
Newton, Mass., April 24, 2011
The point is that "managed care" as rational care in another iteration will be necessary. To support my view and without a personal attack: In "The Ryan Plan for Medicaid" http://nyti.ms/k63B4i
"There are several problems with [the Ryan Plan], starting with that inflation-pegged rate of growth, which could not possibly keep pace with the rising cost of medical care. The Congressional Budget Office estimates that federal payments would be 35% lower in 2022 than currently projected and 49% lower in 2030.
To make up the difference, states would probably have to cut payments to doctors, hospitals or nursing homes; curtail eligibility; reduce benefits; or increase their own payments for Medicaid. The problems do not end there. If a bad economy led to a sharp jump in unemployment, a state’s grant would remain the same. Nor would the block grant grow fast enough to accommodate expensive advances in medicine, rising demand for long-term care, or unexpected health care needs in the wake of epidemics or natural disasters. This would put an ever-tightening squeeze on states, forcing them to drop enrollees, cut services or pump up their own contributions.
This is not the way to go. The real problem is not Medicaid. Contrary to most perceptions, it is a relatively efficient program — with low administrative costs, a high reliance on MANAGED CARE and much lower payments to providers than other public and private insurance.
The real problem is soaring medical costs. The Ryan plan does little to address that. The health care law, which Republicans have vowed to repeal, seeks to reform the entire system to deliver quality care at lower cost."
_____________________________________
Please visit my related articles, below; they are brief, but if you are one of those who must read the end, first [a la "When Harry Met Sally," Billy Crystal], I suggest you go right to #10.
- Wrong Priorities-I.E., Business Over Patient Needs
- Spending Too Little of Insurance Premiums on You and Me
- Inefficiency That Robs Patients of Their Rights
- Healthcare Organizations Who Think They Can Practice Medicine
- The Phenomenon of a Captive Audience
- Access Problems Creates a Flood of Downstream Costs
- Less Costly Trumps Effective
- Callous Disregard for Patients in Their Time of Need
- Failure to Observe the Cardinal Rule of Medicine: First of All, Do No Harm.
- Failure to Observe the Cardinal Rule of Managing Care—Measure and Manage!
