Tag: "doctors"

“Transparency” Will Not Fix Medicare Physician Fees

The Government Accountability Office (GAO) has released a report criticizing the way the federal government sets physicians’ fees in Medicare. It concludes that “Better Data and Greater Transparency Could Improve Accuracy.”

I doubt it. Note the mind-numbing detail of this process: The government delegates its assumed authority to a group of physicians who comprise the Relative Value Scale Update Committee (RUC). The government “reviewed 1,278 RUC work relative value recommendations for about 1,200 unique (new and existing) services)” in the last four years.

High U.S. Health Prices From “Market Power”?

The National Academy of Social Insurance (NASI) recently published a consensus report on provider consolidation. Basically, we have a growing problem in that hospitals are buying each other up and also physician practices, which leads to reduced competition and higher prices.

The report was promoted with an op-ed in The Hill by the esteemed Robert A. Berenson (Urban Institute) and G. William Hoagland (Bipartisan Policy Center):

The use of market power—or the ability to raise and keep prices higher than would prevail in a competitive market – is the key reason the United States spends so much more on healthcare than other countries.
For policymakers, tackling the lack of competition is like climbing a mountain. Even the initial steps — creating more competition – may be difficult, but they must be explored before more regulatory action further down the path is considered.

These are remarkable statements; and difficult to accept uncritically.

Draining More Brains: Where Medicine is Heading

Watching the Affordable Care Act roll-out and reading about its gestation in Steven Brill’s book, America’s Poison Pill, makes one very aware that there is a serious brain drain under way in medicine.  Here’s what anyone can see:

Numbers of applicants to medical school, which once was 10 for every place, is now less than 1.  Physicians are telling their children not to go into medicine. There is now more than a 7 foot stack of regulations for the Affordable Care Act. As we all know, the slogan for this whole program has been “the healthcare system is broken.”  (If that is so true, why force feed new people into it?)

Some manifestations:  the adoption of the ICD-10 coding system, which defines conditions needing care in such detail that there is an unacknowledged administrative cost for compliance and a substantial legal and financial risk if there is mis-coding. Another is the forced adoption of Electronic Medical Records, with rules for “Meaningful Use.” This will produce electronic oversight of all medical care, in the guise of supporting “quality of care” and facilitating “Value-based Payments.”  Ultimately, the government regulators expect to have real time access to any person’s care and any physician’s performance.

Are Doctors Becoming Democrats?

Confident DoctorsNew research published in JAMA shows that political giving by physicians has swung significantly towards Democrats and away from Republicans in 20 years or so. In 1993-1994, 69 percent of physicians who made political donations gave to Republicans, and their giving comprised 65 percent of doctors’ political giving. In 2013-2014, 45 percent of doctors who made political donations gave to Republicans, and they comprised 50 percent of doctors’ political giving.

Naturopaths Beat Real Doctors in Online Reviews

If it quacks like a duck……

A study of more than 28,000 online reviews of doctors suggests that American healthcare consumers are fondest of naturopaths, audiologists, oncologists and osteopathic physicians among healthcare specialists, and are least satisfied with care given by psychiatrists, dermatologists, orthopedists and family-medicine doctors.

Ironically, the analysis indicates that generally as a doctor’s level of education and training increases, patient satisfaction actually decreases. (Vanguard Communcations)

Maybe people have a higher bar of expectations for physicians than naturopaths? I hope that is what this survey is telling us.

Is Patient Scheduling Software Valuable to Doctors?

I am a huge fan of entrepreneurs who want to make medical care more productive and consumer friendly. I wish all of them the best of success. Unfortunately, I am concerned that one of the trends attracting venture capital is chasing a shrinking market. That trend is patient-scheduling software in physicians’ offices.

I was at an angel investor pitch off in Arlington, Virginia, yesterday where one such firm was seeking investors. Two great incubator/accelerators, StartUp Health in New York and Rock Health in San Francisco (and, now, New York) have invested in Arsenal Health, inventor of Smart Scheduling.

Firms like this promise algorithms that use data to predict cancellations and no-shows. I suppose this is the flipside of ZocDoc, the remarkably successful business that doctors use to find new patients to fill appointments that have been cancelled.

These are all great ideas. I am just not sure they make sense in the future environment, where there will be surplus of patients and a shortage of doctors. A few years from now, when the U.S. has Canadian-style waiting lists to see specialists, why would a physician invest in technology to manage cancellations and no-shows?

Such technology would be very valuable where there is a surplus of doctors competing for a limited number of patients. But I don’t think anyone anticipates that for U.S. health care. I hope I am wrong.

Republicans Reach for Redemption on Medicare “Doc Fix”

Politico reports that Congressional Republicans might be having second thoughts about the extremely flawed, so-called Medicare “doc fix” legislation that they sent to President Obama a few days ago. One of those flaws was that the spending in the bill was not offset by cuts to other federal spending – which is why almost every Democrat in Congress voted for it too.

Well, they appear to be getting the message that NCPA has been sending them since March 25:

…… one GOP source said negotiators had resolved a sticking point over how to offset a recently enacted bipartisan Medicare overhaul that was not entirely paid for. The source said the agreement is likely to offset the overhaul, often called the “doc fix,” starting next year.

Better late than never. How they will get President Obama to sign any bill that offsets spending that was already committed by his signature on March 15 is unclear. (All they had to do in the original bill was remove two short sentences that exempted the spending from the so-called PAYGO scorecards. Had they done so, they would not have to worry about it today.)

Barack Obama Has the Last Word on the Medicare “Doc Fix”

I thought that I had given the last word on the flawed Medicare “doc fix” last Monday. Nope: That honor goes to President Obama. During the three week period the secretly negotiated “doc fix” legislation was being rushed through Congress (“rushed” because the Senate was in recess for most of it), I wrote an article suggesting Republicans who voted for it might be casting their first vote for Obamacare. Well, don’t take my word for it. Now that he’s signed the bill, President Obama has hosted a fabulous garden party for the politicians who voted for it. Yahoo has the whole story, including a photo of Speaker Boehner planting a bipartisan kiss on the cheek of Minority Leader Pelosi. One of my charges was that the law increased federal control of the practice of medicine.

Here’s what the President had to say about that:

“I shouldn’t say this with John Boehner here, but that’s one way that this legislation builds on the Affordable Care Act,” Obama said, adding, “But let’s put that aside for a second.”

“Doc Fix”: The War of All Against All Begins!

The U.S. Senate passed H.R. 2, the so-called Medicare “doc fix,” 92-8 last night.  By the time you read this, President Obama will likely already have signed it. He’s eager to do so, because it locks in Obamacare’s vision of the relationship between physicians and the state.

This was a seriously flawed bill, as NCPA has discussed exhaustively (here and here). Now, doctors and patients will have to get used to a new reality where the federal government and beltway lobbyists’ priorities are more deeply embedded in physicians’ offices than ever.

Billy Wynne at the Health Affairs blog has a very good, dispassionate response to the bill’s passage. Wynne starts by describing the Merit-Based Incentive Payment System (MIPS):

Who’s To Blame For Doctors’ Cash Flow Crisis?

Doctors never cease from complaining about insurers’ bureaucracy. It’s one reason why they cannot stand the repeated Medicare “doc fixes” that have occurred at least once a year for over a decade: When Congress does not increase the physician fee schedule before the previous fix runs out, they fear that Medicare contractors will slow roll their claims, creating a big cash flow problem.

(That’s one reason why the lobbyists supporting today’s fiscally irresponsible “doc fix” waited until March 19 to let us know it was coming to the House of Representatives. Last year’s fix expired on March 31. Delaying until the last minute means the lobbyists can more easily drive politicians into a panicked herd and head them off a fiscal cliff.)

The cash flows can be observed by patients, who receive physicians’ invoices and insurers’ Explanation of Benefits (EOBs). One reader went to the doctor on July 31, 2014. As shown in the graphic below, the health plan processed the claim on August 25 and mailed it to the beneficiary on August 29.