Wednesday, May 27, 2015

Maine Doctors Choosing Direct Pay Model

From Maine Public Radio: "Awash in Paperwork, Maine Doctors Abandon Conventional Treatment Model".

More real-world experience shows how direct-pay medicine benefits both patients and physicians alike.  From the piece:
[Family physician Dr. Catherine] Krouse says the way health care has evolved, patients often come second to the other demands on doctors:  Filling out reimbursement forms. Calling insurance companies to battle for claims. Reviewing and signing off on stacks of patient paperwork.

"You just end up getting drained and drained and drained," Krouse says. "And then when your cup is completely empty, then you just get guarded and angry. And then you put up walls, and that really creates barriers."

So Krouse decided to set up a direct primary care practice. Earlier this month she opened Lotus Family Practice in Falmouth. She doesn't accept insurance. Instead, she charges patients a monthly membership fee. "So it's very direct. It's just patients and doctors. There's no one else in between."
Membership is $60 a month for adults, $20 for kids. It covers an unlimited number of visits, which last about 45 minutes. Patients can also call or text Krouse any time they want. She also provides generic drugs at wholesale cost. Those savings alone, she says, can cover the cost of membership. "Pennies. They cost pennies."
The article goes into more detail on how this helps physicians spend more time with patients and get to the root of their health problems.  Plus patients need fewer referrals to specialists.

In summary:
The direct primary care model, [Krouse] says, allows her to move beyond just treating illness to focusing on health, well being, and the individual patient. And that's the kind of doctor that Krouse has always wanted to be.
(Article link via Dr. Megan Edison and Dr. Matthew Bowdish.)  

Wednesday, May 13, 2015

Unethical Doctors

There are some jaw-dropping stories here: "Doctors of Reddit, what is the most unethical thing you have done or you have heard of a fellow doctor doing involving a patient?"

For those following health care policy, this anecdote is relevant:
I briefly worked at the front desk clerk for an ER at a local hospital. The rule was the anyone that came in complaining of chest pains had to be back and on a machine within 10 minutes of arrival. Once I entered their name into the system a clock started. So I was told not to enter their name until they had already been taken back to essentially make our numbers look better and make it appear as though they were receiving care within the prescribed 10 minutes.

Edit: People complaining of chest pains were typically brought back quickly, just not always within the 10 minute guideline, although generally faster than anyone else. This mostly seemed to be just about producing better stats. Although keeping it off the system gave them the ability to delay.

"There are three kinda lies in the world; lies, damned lies, and statistics."
 (Via White Coat blog.)

Friday, May 8, 2015

Hsieh Forbes Column: FDA Vs. Free Speech

My latest Forbes column is now up: "Drug Company Amarin Stands Up For Free Speech Against FDA".

Here is the opening:
Even as Americans heatedly argue the issue of free speech with respect to cartoon criticisms of Islam, the small drug company Amarin is striking a quieter blow for its free speech rights against the Food and Drug Adminstration (FDA).

The key issue is whether drug companies can tell doctors truthful information about their products that pertains to “off-label” uses (i.e., for applications not already explicitly approved by the FDA.)
Of course, drug companies should not be allowed to disseminate false or misleading information about their products.  That can and should be punished as fraud.

But both doctors and patients benefit when drug companies are allowed to publish truthful information.

Bonus infographic on the onerous FDA approval process!

Friday, May 1, 2015

Light Posting

Posting may be lighter than usual for a while, due to external circumstances.

Wednesday, April 29, 2015

Cleveland Clinic Empathy Video

This is change of pace from the health policy posting.

But I wanted to share this moving short video from the Cleveland Clinic on the hundreds of behind-the-scenes stories every day in the hospital. (I recently saw it a medical conference I attended earlier this month.)

Thank you.

Monday, April 27, 2015

Hsieh Forbes Column: Perverse Incentives and VA Health Scandals

My latest Forbes column is now up: "Perverse Incentives and VA Health Scandals".

I discuss the perverse incentives underlying the numerous VA health scandal. Too many on the political Left (such as New York Times columnist Paul Krugman) are quick to condemn perverse incentives in the private health system, while failing to mention similar (or worse) perverse incentives in government-run health systems.

Incentives matter.

Tuesday, April 14, 2015

Doc Fix Critiques

Three recent negative critiques of the Medicare "Doc Fix":

"House 'Doc Fix' Bill Makes Things Worse, Medicare Analysis Finds" (Chris Jacobs, Wall Street Journal)

"Medicare Doc Fix Bill Is IPAB-Lite" (David Hogberg, Daily Caller)

"Medicare fix needs fixing" (Theodore Marmor, Philadelphia Inquirer)

In particular, the Hogberg piece notes the perverse incentives that will pressure doctors skimp on care to patients as part of cost containment.  But all three are worth reading.

Monday, April 13, 2015

Perry: Lessons From Cosmetic Surgery Markets

Economist Mark Perry has a written a nice review, "What economic lessons about health care can we learn from the market for cosmetic procedures?"

In general, these services are not covered by insurance but rather paid for by the consumers themselves.  Hence, consumers have a keen interest in finding the best value for their medical dollar.

As a result, prices have essentially stayed stable (or decreased significantly) after adjusting for inflation.  In some case, the prices have gone down in nominal dollars as well!

As Perry notes:
Most importantly, none of the ten cosmetic procedures in the table above have increased in price by anywhere close to the 88.5% increase in medical care services since 1998.  [Emphasis his.]
Perry summarizes:
The competitive market for cosmetic procedures operates differently than the traditional market for health care in important and significant ways. Cosmetic procedures, unlike most medical services, are not usually covered by insurance. Patients paying out-of-pocket for cosmetic procedures are cost-conscious, and have strong incentives to shop around and compare prices at the dozens of competing providers in any large city.

Because of that market competition, the prices of almost all cosmetic procedures have fallen in real terms since 1998, and some non-surgical procedures have even fallen in nominal dollars before adjusting for price changes. In all cases, cosmetic procedures have increased in price by less than the 88.5% increase in the price of medical care services between 1998 and 2014.
In other words, the problem we've seen of skyrocketing prices in the traditional medical market can't be blamed on "fee for service". Rather, the issue is the 3rd-party payor system, a point also made by others such as Dr. Richard Amerling in his recent Wall Street Journal piece.

Proper treatment of a problem requires a proper diagnosis, in public policy as well as in medicine.  Perry's work is an important pointer in the right direction.