1) Medicare is finding out that preventive care may cost more money in the short term.
My take: The mantra of Barack/Hillarycare the current health reform proposals is that it will be partially paid for by an emphasis on preventive care.
Wrong.
Studies have shown, and Medicare is finding out, that preventive care will be more expensive at first. The savings, if any, will be realized generations down the road. I doubt there will be the political patience for that.
The only way for instant savings is to say “no” and to ration care. Medicare will find out soon enough.
2) Dartmouth Atlas comes out with their latest report, suggesting that the intensity of end-of-life care can be a huge cost contributor.
My take: More medicine doesn’t necessarily mean better care. An oft-repeated theme here. This is especially true in the end-of-life setting.
Patients need to accept this counter-intuitive conclusion. As long as there are family members who “want everything done”, and back that up with threats of lawsuits, physicians will have little say in the matter.
Publicizing and accepting the findings of the Dartmouth Atlas Project is a small but essential step in educating the public.
3) Emerging guidelines are suggesting oncologists start to discuss cost with patients when talking about cancer therapy.
My take: As our health care system spirals into fiscal oblivion, this movement will spread to other fields.
In medical school, doctors are taught to do what’s in the patient’s best interest. Cost was often not part of the equation. “Money should not get in the way of patient care” was the mantra.
Times are changing. Financial concerns weigh heavily on a patient’s mind, and now play a significant role in many medical decisions.
4) Grady Memorial Hospital in Atlanta gets bailed out with a $200 million gift.
My take: Solves the symptom, not the disease. Charity hospitals are teetering on bankruptcy, as they are not paid for the large proportion of uninsured patients they serve.
I have no doubt that Grady will find itself in a similar situation very soon.
Related posts:
- Does preventive medicine save money or cost more in the long run?
- Angioplasty in a healthy patient, and why preventive heart care is dismissed
- Palliative care and cost savings
- Grady Hospital: "The slowly-boiled frog"
- My take: Preventive care, geriatricians, lifestyle
- Does preventive medicine really save money?
- "If you give him anymore morphine, I will sue you"
{ 3 comments }
“As long as there are family members who “want everything done”, and back that up with threats of lawsuits, physicians will have little say in the matter.”
As long as we have physicians who are unwilling to do their jobs or for that matter take control of their financial situations, and blame everyone else for those failures, not much will change.
Primary care as preventive care misses the mark and misses the opportunity to make a real difference. Much of the expenditure of massive resources in the last month of life, much of family members wanting “everything done” is avoidable when instead of primary care, what one has is comprehensive care by a trusted family physician who has been through all the ups and downs with the extended family, who takes care of their patient with the occasional consultant. It is nearly a dead model now but was the norm 30 years ago. In that scenario, there is someone with a trusted authoritative voice who can say “I don’t think you want to do that” or “It is time to back and let nature’s take it’s course”.
As a former Grady resident, I have fond memories of the place and all that I learned there.
That said, all public hospitals have financial issues. Grady has even worse financial problems. There are more “middle managers” and administrative types than there are residents, nurses, and janitors comibined. It makes the other public hospitals in the US look efficient by comparison.
Atlanta, and indeed all of Georgia, needs Grady, and it needs Grady to function. But it ought to include some sort of real management firm (?Hunter group?) along with the gift of $20 million.
Otherwise Kevin’s predictions (that Grady will soon be bankrupt again) will be correct within months.
And, as to anon 7:21 – you’re right. As long as it’s easier to say “whatever the family wants” instead of “whatever is in the pt’s best interest” the current chaos will not change much.
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