Tuesday, March 31, 2015

Amerling Vs. Ginsburg on Fee For Service

The Wall Street Journal recently published a nice pair of columns on both sides of the issue, "Should the U.S. Move Away From Fee-for-Service Medicine?"

The anti-fee-for-service side was taken by Paul Ginsburg.  The pro-FFS side was taken b Richarad Amerling.

I basically agree with Dr. Amerling and I want to quote a couple of excerpts from his piece:
The real cause is the institution and growth of direct third-party payments. Inflation in health care was trivial until the mid-1960s, when Medicare and Medicaid were thrust into existence. The other big driver is the morphing of health insurance into a prepayment model, where even routine, low-cost care is covered. When neither the consumer nor the provider “feels” the cost of the service offered, it promotes overuse of medical services and high levels of spending. Government data show that 48% of health dollars were “out of pocket” in 1960. By 2008, this was down to 12%...

In other professions that feature fee for service but where third-party payments play a much smaller role, such as in law, dentistry or veterinary medicine, there is little excessive price inflation. Similarly, in areas of medicine outside the third-party-payment system, such as cosmetic surgery, Lasik eye surgery, and direct pay practices, prices have actually declined over time.

It is impossible to eliminate self-interest, which is embedded in human nature. But if some doctors and hospitals over time get away with unnecessary tests or padding bills, it isn’t because of fee for service. It’s because the patients are shielded from the impact by third-party payments.

Fee for service directly aligns payments with care, which is what most patients want, especially when facing serious illness. It’s incentive-based and increases the likelihood of quality care in a timely manner...
But I highly recommend reading both sides of this debate, "Should the U.S. Move Away From Fee-for-Service Medicine?"

Here is the related video.

Monday, March 30, 2015

Hsieh Forbes Column: 18-Year-Olds Should Be Allowed to Smoke

My latest Forbes column discusses the latest debate over raising the legal age for smoking: "Smoking Is Bad, But 18-Year-Olds Should Be Allowed to Smoke".

In particular, any debate on this should include the following three questions:
1) Is it the government’s job to stop legal adults from making unhealthy life choices?

2) Is it right for the government to restrict the freedom of adults over 18, because others under 18 might be more tempted to smoke?

3) Whose body is it, anyways?
People don't always make the best choices for themselves.  But in a free society, they should be able to do so, provided they aren't violating the rights of others.

Wednesday, March 25, 2015

Bad Health Tech

The New York Times recently ran a surprisingly good article, "Why Health Care Tech Is Still So Bad".

From the article:
A friend of mine, a physician in his late 60s, recently described a visit to his primary care doctor. “I had seen him a few years ago and I liked him,” he told me. “But this time was different.” A computer had entered the exam room. “He asks me a question, and as soon as I begin to answer, his head is down in his laptop. Tap-tap-tap-tap-tap. He looks up at me to ask another question. As soon as I speak, again it’s tap-tap-tap-tap.”

“What did you do?” I asked.

“I found another doctor."
The NYT piece correctly describes how mandatory electronic medical records are putting a barrier between patients and physicians, impeding good medical care.

And even some of the intended "safety" features, such as electronic alerts for wrong prescriptions can cause cognitive overload.  If you're faced with thousands of beeps and alerts each month, your brain quickly starts ignoring them.  It's the electronic equivalent of "crying 'wolf'".

(A related article from the technology field noted how, "MRIs show our brains shutting down when we see security prompts".  I wouldn't be surprised if the same thing happened with physicians coping with never-ending electronic medical record alerts.)

I'm not opposed to technological improvement.  But I am opposed to government mandates ramming technology into hospitals and medical offices based on bureaucrats' preferences, not in response to the genuine needs of physicians.  I love my smartphone --  but I don't think the government should use financial carrots-and-sticks to force everyone to own one.  Nor should the government use financial carrots-and-sticks to force physicians to adopt unwanted (and potentially harmful) electronic medical record systems.

Related stories:
"Can You Trust What's In Your Electronic Medical Record?" (Forbes, 2/24/2014)
"The Eyes of Big Medicine: Electronic Medical Records" (PJ Media, 9/18/2013)

NYT link via Dr. Matthew Bowdish, who also commented:
It breaks my heart whenever a patient tells me that one of the reasons they love our practice is that we look at the patients rather than a computer screen. Little do they know that we already have electronic health records although are holding on full implementation. Not only has the current EHR paradigm almost destroyed our business, it also risks robbing us of our humanity in caring for patients. The promise of technology is huge and necessary. These govt-mandated, tools of Big Insurance are not.

Monday, March 23, 2015

Patients Secretly Recording Doctors

The 3/12/2015 edition of JAMA (Journal of the American Medical Association) discusses "Ethical Implications of Patients and Families Secretly Recording Conversations With Physicians".

I don't think patients should record their physicians without their consent. However, I do strongly favor such recordings when both sides agree, as discussed in my February 2015 Forbes column, "Why You Should Record Your Doctor Visits".

But I also recognize that many states allow such surreptitious recordings with only "one party" (patient) consent.  Hence, I also agree with the JAMA piece that physicians should probably start communicating as if their words were being permanently recorded by the patient.

Tuesday, March 17, 2015

3 Good Things About US Health Care

US health care isn't perfect by any means. But Dr. Suneel Dhand gives us some much-needed perspective in this piece, "You’re lucky to be a patient in America. Here are 3 reasons why."

The three key points include:

1) Getting to see your attending physician every day.

2) Patient empowerment to choose.

3) Putting energy into customer satisfaction and good service in hospitals.

Dr. Dhand discusses each in more detail. For more info, please read the full text of  "You’re lucky to be a patient in America. Here are 3 reasons why."

Friday, March 13, 2015

The Ugly Civil War in American Medicine

The battle over "Maintenance of Certification" (MOC) has finally hit the mainstream press in this informative Newsweek piece, "The Ugly Civil War in American Medicine".

Here is the opening to the article:
Are physicians in the United States getting dumber? That is what one of the most powerful medical boards is suggesting, according to its critics. And, depending on the answer, tens of millions of dollars funneled annually to this non-profit organization are at stake.

The provocative question is a rhetorical weapon in a bizarre war, one that could transform medicine for years. On one side is the American Board of Internal Medicine (ABIM), which certifies that doctors have met nationally recognized standards, and has been advocating for more testing of physicians. On the other side are tens of thousands of internists, cardiologists, anesthesiologists and the like who say the ABIM has forced them to do busywork that serves no purpose other than to fatten the board’s bloated coffers...
For more details, read the rest of "The Ugly Civil War in American Medicine".

Wednesday, March 11, 2015

Proposed Legal Protection For Direct Primary Care in Florida

From Florida, a good idea: "Doctors and nurses could charge patients a set fee and provide services in exchange for that price and not be afoul of the state’s insurance codes under a proposed committee bill unveiled by the House Innovations Subcommittee."

The state of Michigan passed a similar law a couple of months ago.

I hope this idea gains momentum!

Tuesday, March 10, 2015

A Radiologist's Day

As a radiologist, I really appreciated this comic "A Radiologist's Day".  You can click on the image below to see the full-sized version.

(And I bought the t-shirt at CafePress.)