Monday, December 3, 2012

Central Planning Failures

So how are the various central-planning government medical initiatives working out?

"Patient Centered Medical Homes (PCMH)" -- not so well.

In the 11/30/2012 Forbes, Leah Binder notes "A Healthcare Plan That's Failing":
A troubling study in the Annals of Internal Medicine analyzes patient-centered medical homes (PCMH), and shows essentially no cost savings and minimal if any impact on clinical outcomes. This is the latest in a series of analyses notable for their consistent conclusions that the financial impact of PCMH is -- at best -- nonexistent or inconclusive.
How about electronic medical records?

The 11/30/2012 edition of Colorado Public Radio describes, "Colorado Docs' Difficult Digital Transition:
Wilkerson: We were told by sales people that we would make more money because we’d be more efficient, and you’d be able to see more patients,  We’d be able to bill faster, get the money in the bank at the push of a button. And none of that panned out.

Reporter: Wilkerson says they were told the practice would be able to see 25% more patients, meaning: more income. But she and her partners found they actually had to cut back on the number of people they could see.

Wilkerson: For the first couple months we were really probably only seeing 50%, and then tried to rampup to 75%. I’d say I never got above 80-85% of what I’d seen before, just because it’s time consuming.

Reporter: That meant Wilkerson and her partners were taking an unexpected financial hit, right after they’d borrowed $200,000 to buy the medical records software and the computers to run it.
And ObamaCare rules driving doctors out of private practice and into becoming hospital employees?

Two quotes from the 12/1/2012 New York Times article, "A Hospital War Reflects a Bind for Doctors in the U.S." contrast the theory with practice.

Here's the theory:
Many policy experts praise the shift away from independent practices as a way of making health care less fragmented and expensive. Systems that employ doctors, modeled after well-known organizations like Kaiser Permanente, are better able to coordinate patient care and to find ways to deliver improved services at lower costs, these advocates say. Indeed, consolidation is encouraged by some aspects of the Obama administration’s health care law
But here's how it works out in actual practice:
Across the country, doctors who sold their practices and signed on as employees have similar criticisms. In lawsuits and interviews, they describe growing pressure to meet the financial goals of their new employers — often by performing unnecessary tests and procedures or by admitting patients who do not need a hospital stay.
The utopian visions of central planners failed to work for the economies of the Eastern Bloc countries.  There's no reason to think it will work for American health care. 

(CPR link via Ari Armstrong.  NYT link via Dr. Donald Palmisano.)