Comments on: Rationing care is inevitable to control health care costs http://www.kevinmd.com/blog/2009/07/rationing-care-is-inevitable-to-control-health-care-costs.html Wed, 15 Feb 2012 00:27:00 +0000 hourly 1 By: Dr. Weshttp://www.kevinmd.com/blog/2009/07/rationing-care-is-inevitable-to-control-health-care-costs.html#comment-105534 Dr. Wes Thu, 09 Jul 2009 22:56:23 +0000 http://www.kevinmd.com/blog/?p=37854#comment-105534 While prevention is a good thing, when it comes down to controlling health care costs, there's one chronic disease that's tough to prevent: old age. While prevention is a good thing, when it comes down to controlling health care costs, there’s one chronic disease that’s tough to prevent: old age.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2009/07/rationing-care-is-inevitable-to-control-health-care-costs.html#comment-105436 Anonymous Thu, 09 Jul 2009 21:09:18 +0000 http://www.kevinmd.com/blog/?p=37854#comment-105436 Unless you are willing to abuse the emergency room, medical care is already rationed unless you are rich enough to self-insure (and therefore be able to make decisions based purely on your own cost / benefit, not what someone else thinks). Most people are limited by the limitations of what their insurance companies (government or private) are willing to pay for (and insurance companies sometimes inappropriately deny payment, apparently hoping that you don't notice enough to point out that the policy stated that they should have paid). Unless you are willing to abuse the emergency room, medical care is already rationed unless you are rich enough to self-insure (and therefore be able to make decisions based purely on your own cost / benefit, not what someone else thinks). Most people are limited by the limitations of what their insurance companies (government or private) are willing to pay for (and insurance companies sometimes inappropriately deny payment, apparently hoping that you don’t notice enough to point out that the policy stated that they should have paid).

]]> By: Jeff Brandthttp://www.kevinmd.com/blog/2009/07/rationing-care-is-inevitable-to-control-health-care-costs.html#comment-105428 Jeff Brandt Thu, 09 Jul 2009 20:01:05 +0000 http://www.kevinmd.com/blog/?p=37854#comment-105428 TexBryant, Great response. Education and Awareness is a major part of correcting any problem weather it is smoking cessation or getting the right person to assist in correcting a problem. It has to start with the decision makers, weather that is the smoker, the hospital CEO, or congressmen. The more we talk, motivate, and execute the closer we will come to a solution that works for everyone.We our hoping that PHRs both mobile and Web based will assist with one small portion of the problem to help people be more aware of their health.Jeff Brandt motionPHR for the iPhone MyMotionMedBox for Android TexBryant,
Great response. Education and Awareness is a major part of correcting any problem weather it is smoking cessation or getting the right person to assist in correcting a problem. It has to start with the decision makers, weather that is the smoker, the hospital CEO, or congressmen. The more we talk, motivate, and execute the closer we will come to a solution that works for everyone.

We our hoping that PHRs both mobile and Web based will assist with one small portion of the problem to help people be more aware of their health.

Jeff Brandt
motionPHR for the iPhone
MyMotionMedBox for Android

]]> By: TexBryanthttp://www.kevinmd.com/blog/2009/07/rationing-care-is-inevitable-to-control-health-care-costs.html#comment-105211 TexBryant Thu, 09 Jul 2009 13:16:24 +0000 http://www.kevinmd.com/blog/?p=37854#comment-105211 In 1973 President Nixon signed a bill which introduced HMO care into Medicare. It was championed as a solution to rising health care costs which were rising then. Nixon wanted more in the way of health care reform and national coverage, but a recession at the time prevented that. Here we are, about 36 years later, attempting to reign in costs again.The problem is complex but there are some good examples of success in reining in costs while providing good care. Physicians do not have to suffer while achieving these successes. Some examples that are worthy are the Baldrige Award recipients in health care. The hospitals that receive the awards are in good financial shape while providing good service in their patients eyes and also keeping down the cost per patient.The two year national project of TransforMed has demonstrated that primary care physicians can improve their income and provide good care to their chronic care patients, using principles based primarily on Wagner's Chronic Care Model. In fact, the average physician's income rose 14% in the program while the cost per patient dropped.As far as prevention is concerned, promoting good lifestyle is indeed a worthy cause but it should not fall upon the health care community to drive prevention solely. There was a research project in Somerville, Massachusetts funded by a government grant whose aim was to decrease the growth in the BMI of children in grades 1 through 3 at the public schools. The program was successful because the whole community was involved. The lesson learned, prevention activities are successful based upon local community involvement. Another very successful prevention program has been tobacco cessation. In the 1950's doctors were advertising cigarette smoking! Today, they are actively campaigning against it. They are not alone, though. Other avenues besides health care have been involved in the this campaign, including the government, schools, and media.My point, there are demonstrable successes in reining in health care costs while improving the lot of the providers and there are excellent approaches to prevention which do not rely solely on the heath care community.Do we dare hope that Congress and the President will follow successful models? In 1973 President Nixon signed a bill which introduced HMO care into Medicare. It was championed as a solution to rising health care costs which were rising then. Nixon wanted more in the way of health care reform and national coverage, but a recession at the time prevented that. Here we are, about 36 years later, attempting to reign in costs again.

The problem is complex but there are some good examples of success in reining in costs while providing good care. Physicians do not have to suffer while achieving these successes. Some examples that are worthy are the Baldrige Award recipients in health care. The hospitals that receive the awards are in good financial shape while providing good service in their patients eyes and also keeping down the cost per patient.

The two year national project of TransforMed has demonstrated that primary care physicians can improve their income and provide good care to their chronic care patients, using principles based primarily on Wagner’s Chronic Care Model. In fact, the average physician’s income rose 14% in the program while the cost per patient dropped.

As far as prevention is concerned, promoting good lifestyle is indeed a worthy cause but it should not fall upon the health care community to drive prevention solely. There was a research project in Somerville, Massachusetts funded by a government grant whose aim was to decrease the growth in the BMI of children in grades 1 through 3 at the public schools. The program was successful because the whole community was involved. The lesson learned, prevention activities are successful based upon local community involvement. Another very successful prevention program has been tobacco cessation. In the 1950′s doctors were advertising cigarette smoking! Today, they are actively campaigning against it. They are not alone, though. Other avenues besides health care have been involved in the this campaign, including the government, schools, and media.

My point, there are demonstrable successes in reining in health care costs while improving the lot of the providers and there are excellent approaches to prevention which do not rely solely on the heath care community.

Do we dare hope that Congress and the President will follow successful models?

]]> By: family practitionerhttp://www.kevinmd.com/blog/2009/07/rationing-care-is-inevitable-to-control-health-care-costs.html#comment-105195 family practitioner Thu, 09 Jul 2009 13:05:17 +0000 http://www.kevinmd.com/blog/?p=37854#comment-105195 Why didn't the ent discuss it with them? I know it is best for primary care to do, but in the absence of sufficient primary care, specialty care should step up to the plate.In my neck of the woods, we, as primary care, are frequently pleading with the patient and family to consider hospice; it is the specialists, particularly the oncologists, who push for treatment. And you know what? We are ALWAYS right, the patient is still dead in 1-3 months, albeit with more suffering and higher cost to society. Why didn’t the ent discuss it with them? I know it is best for primary care to do, but in the absence of sufficient primary care, specialty care should step up to the plate.

In my neck of the woods, we, as primary care, are frequently pleading with the patient and family to consider hospice; it is the specialists, particularly the oncologists, who push for treatment. And you know what? We are ALWAYS right, the patient is still dead in 1-3 months, albeit with more suffering and higher cost to society.

]]> By: rayhttp://www.kevinmd.com/blog/2009/07/rationing-care-is-inevitable-to-control-health-care-costs.html#comment-104882 ray Thu, 09 Jul 2009 06:32:59 +0000 http://www.kevinmd.com/blog/?p=37854#comment-104882 Saw this 70 something gentleman with advanced laryngeal cancer with PEG tube and on dialysis, losing weight rapidly despite treatment. The ENT doctor expressed that he was someone who should consider Hospice given his condition. He had no primary care and his nephrologist( private) was sort of his primary who did not pay heed to what other specialist were recommending. Unfortunately family and patient were spanish speaking and had lots of barriers and followed the nephrologist's advice, he got dialysed until his last day and his nephrologist never discussed hospice option with family. He died in ICU. I find this very disturbing that there is a huge disparity in the way hospice services are used. Why is left to the whim of the doctor rather than being mandatory that patient should be made aware of his options. There is no excuse to put patients through agony at end of life unless the patient wants it. Saw this 70 something gentleman with advanced laryngeal cancer with PEG tube and on dialysis, losing weight rapidly despite treatment. The ENT doctor expressed that he was someone who should consider Hospice given his condition. He had no primary care and his nephrologist( private) was sort of his primary who did not pay heed to what other specialist were recommending. Unfortunately family and patient were spanish speaking and had lots of barriers and followed the nephrologist’s advice, he got dialysed until his last day and his nephrologist never discussed hospice option with family. He died in ICU. I find this very disturbing that there is a huge disparity in the way hospice services are used. Why is left to the whim of the doctor rather than being mandatory that patient should be made aware of his options. There is no excuse to put patients through agony at end of life unless the patient wants it.

]]> By: HospiceDochttp://www.kevinmd.com/blog/2009/07/rationing-care-is-inevitable-to-control-health-care-costs.html#comment-104625 HospiceDoc Wed, 08 Jul 2009 23:08:24 +0000 http://www.kevinmd.com/blog/?p=37854#comment-104625 And at the same time they are threatening huge cuts to hospice payments that could put a substantial number of them, especially non-profits, out of business. At the same time they are cutting eligibility and cracking down on lengths of stay even a day over 6 months. So they will be sent "to hospice" to die...only there may not be a hospice there and they may not even meet the government's criteria to get into hospice. So maybe just go home and die? And if you get into hospice then we euthanize you on day number 181 if you are still alive? And at the same time they are threatening huge cuts to hospice payments that could put a substantial number of them, especially non-profits, out of business. At the same time they are cutting eligibility and cracking down on lengths of stay even a day over 6 months.
So they will be sent “to hospice” to die…only there may not be a hospice there and they may not even meet the government’s criteria to get into hospice. So maybe just go home and die? And if you get into hospice then we euthanize you on day number 181 if you are still alive?

]]> By: Billhttp://www.kevinmd.com/blog/2009/07/rationing-care-is-inevitable-to-control-health-care-costs.html#comment-104563 Bill Wed, 08 Jul 2009 20:45:14 +0000 http://www.kevinmd.com/blog/?p=37854#comment-104563 Whoops, I meant to say:http://tinyurl.com/mx9xfjBill Whoops, I meant to say:

http://tinyurl.com/mx9xfj

Bill

]]> By: Doc99http://www.kevinmd.com/blog/2009/07/rationing-care-is-inevitable-to-control-health-care-costs.html#comment-104561 Doc99 Wed, 08 Jul 2009 20:08:00 +0000 http://www.kevinmd.com/blog/?p=37854#comment-104561 Comparative effectiveness is a rationing system that weighs the costs of treatment against the relative value of the person getting treated. The people most likely to be affected by “comparative effectiveness” rationing in a single-payer system are the elderly. Stuart Altman explained that all too well to Congress earlier this year:Remember, our population is aging. And with the very, very elderly, the costs go down, so that percentage should be falling, and it’s not. Second, the cost of care is growing by so much, so at the same percentage, it’s worth a lot more. So let’s go back to the issue of comparative effectiveness, which we’re supporting. That’s where that can have a big impact. It’s not only there, but that’s where the waste is. That’s where people are using technologies that really either don’t work at all or keep people alive for for very limited [time] and [at] very high cost.Hospice is one option, but we do need take account of the cost — you know, I hate to say it, the cost-benefit of some of the things we do. And either we can do it directly, or we can do it by bundling the payments and let the delivery system deal with it. So it’s a combination of the delivery system dealing with it, or, and/or providing more information for people to make the right decisions, both for themselves and for the care.Basically, the government will tell some people that they’re just not worth the effort to treat, and will send them to hospice to die instead.http://hotair.com/archives/2009/07/08/who-says-no-in-a-government-run-health-care-system/ Comparative effectiveness is a rationing system that weighs the costs of treatment against the relative value of the person getting treated. The people most likely to be affected by “comparative effectiveness” rationing in a single-payer system are the elderly. Stuart Altman explained that all too well to Congress earlier this year:

Remember, our population is aging. And with the very, very elderly, the costs go down, so that percentage should be falling, and it’s not. Second, the cost of care is growing by so much, so at the same percentage, it’s worth a lot more. So let’s go back to the issue of comparative effectiveness, which we’re supporting. That’s where that can have a big impact. It’s not only there, but that’s where the waste is. That’s where people are using technologies that really either don’t work at all or keep people alive for for very limited [time] and [at] very high cost.

Hospice is one option, but we do need take account of the cost — you know, I hate to say it, the cost-benefit of some of the things we do. And either we can do it directly, or we can do it by bundling the payments and let the delivery system deal with it. So it’s a combination of the delivery system dealing with it, or, and/or providing more information for people to make the right decisions, both for themselves and for the care.

Basically, the government will tell some people that they’re just not worth the effort to treat, and will send them to hospice to die instead.

http://hotair.com/archives/2009/07/08/who-says-no-in-a-government-run-health-care-system/

]]> By: Billhttp://www.kevinmd.com/blog/2009/07/rationing-care-is-inevitable-to-control-health-care-costs.html#comment-104560 Bill Wed, 08 Jul 2009 20:03:28 +0000 http://www.kevinmd.com/blog/?p=37854#comment-104560 On the other hand:Bill On the other hand:

Bill

]]>