Results found: 110

Permalink:

Why Aren’t Physicians Upset About Obamacare?

June 6, 2012

• Leave a comment

IF YOU CANNOT SEE THE YOU TUBE PRESENTED IN THIS BLOG POST IN YOUR EMAIL OR YOUR RSS FEED PLEASE CLICK ON TO THE TITLE OF THIS BLOG POST ABOVE TO CONNECT TO THE ORIGINAL ONLINE BLOG POST OR OPEN THE URLS POSTED IN THE EMAIL OR RSS FEED.

Stanley Feld M.D.,FACP,MACE

Physicians are upset. They have been marginalized during the entire healthcare reform debate.

Patients are upset about Obamacare. Many states are upset about Obamacare. These states are suing President Obama and his administration for impinging on states rights.

Recent approval /disapproval polls on average showed that patients disapprove of Obamacare by a 43.1%/52.2% average..

“Do you approve/disapprove of Obama's handling of health care?

Some of the polls included in the average may be outdated since the latest poll for each of the pollsters are averaged in. “

Pollster	Date	Approve	Disapprove
AVERAGE		43.1%	52.2%
CNN ORC	3/25-28/10	45	54
ABC Washington Post	3/23-26/10	48	49
Quinnipiac	3/22-23/10	44	50
CBS NYT	3/22-23/10	47	48
NBC	3/11,13-14/10	41	57
AP GFK	3/3-8/10	49	46
Fox	2/23-24/10	37	56
USA Today Gallup	2/1-3/10	36	60
Bloomberg	12/3-7/09	40	53
Marist	10/7,8&12/09	44	49

A critical question in all of this is, “ Why are we not hearing from physicians?”

There are several reasons for the public not hearing from physicians.

First, the is practicing physicians’ input has been muted or ignored by President Obama, his administration and the traditional media.

The members of the Association of American Physicians and Surgeons are on the front lines of caring for patients and would like to discuss the bill's effect on the patient-doctor relationship. Media coverage has been poor or non existant.

This You Tube expresses the AAPS view of Obamacare’s effect on the patient-physician relationship. It features Congressman Michael C Burgess, MD, Jane Orient, MD, & Richard Amerling, MD.. This briefing was held in the Canon House office Building in Washington DC on May 26, 2011.

http://youtu.be/5R5f5JhgfcM

For many years physicians relied on the AMA for leadership. There is no leadership from the AMA at this time.

Second, the majority of physicians don’t see eye to eye with the AMA on Obamacare. There have been many reports of physicians fleeing the AMA because of a lack of leadership and advocacy for practicing physicians’ views. The AMA has not represent physicians and their patients’ interests.

“Obamacare changes the health care system in several ways that harm physicians. It also fails to address the pivotal issues facing physicians today—for example, low government reimbursement rates that fail to cover the cost of care, or the need for state-by-state medical malpractice reform.”

The AMA is out of touch with practicing physicians’ views.

During the health care reform debate, the American Medical Association (AMA) emerged as one of the new law’s supporters. But rather than symbolizing physicians’ support for the left’s health care overhaul, the AMA’s stance on Obamacare just proves how detached the organization has become from physicians’ best interests.

A physician survey by Jackson and Coker affirms this growing gap between the AMA and physicians the AMA should represent. The survey showed:

Only 11 percent of the physicians surveyed agreed that “the AMA’s stance and actions represent my views.” Of those who are members of the AMA, only 40 percent agreed.
13 percent of all physicians, and just 35 percent of AMA members, agreed with the AMA’s position on health reform; 70 percent disagreed.
Of those who had dropped their AMA membership, 47 percent said it was because of the AMA’s support for Obamacare, and 43 percent who said AMA’s ideology was too far to the left.
Only 15 percent of physicians considered the AMA a successful advocate of physicians’ issues. 75 percent of physicians surveyed said that “the AMA no long represents physicians.

Physicians need a more representative voice. Sermo has been moderately successful but has not been permitted to have an appropriate hearing in the traditional media.

A recent polling underscores deep physicians' discontent.

Athena Health and Sermo did a recent survey of physicians

1. 79 percent of physicians are less optimistic about the future of medicine.

2. 66 percent indicated that they would consider dropping out of government health programs.

3. 53 percent would consider opting out of insurance altogether.

Third-party payment arrangements have compromised the independence and integrity of the medical profession.

Obamacare will reinforce the worst of these features in the present healthcare system. Physicians will be subject to more government regulation and oversight and more bureaucratic direction.

At the same time, Obamacare is ignoring the most important issues facing physicians such as Tort Reform, third party payment reform and increasing government red tape.

Physicians will be more dependent on unreliable government reimbursement for medical services. Physicians are presently under tremendous pressure. It will only become worse under Obamacare.

Dr. Martha Boone is an Atlanta urologist. She explains the consequences of the Obamacare. She explains her fears about Obamacare.

Dr. Boone has moved to a less-expensive office to avoid dropping Medicare patients or laying off an employee.

The is a wonderful You Tube.

http://youtu.be/jwae822Sw-4

Medicare and Medicaid reimbursement, are already well below the prevailing rates in the private sector.

Medicare pays physicians 50-80 percent of the negotiated private sector fee.

The negotiated private fees are at least 50% less than the customary fees.

Medicaid pays 15-30% of the already reduced private sector fees. Medicare payment has resulted in sporadic access problems for Medicare patients,

Obamacare is going to lower these fees. We are already seeing serious problems with access to care for Medicaid patients. The result is an increase in hospital emergency room use. This increases the emergency room prices for the private sector as it decreases private sector ER capacity. It also increase healthcare insurance premiums.

Sixty seven (67) percent of primary care physicians said that under current conditions new Medicaid enrollees would not be able to find a “suitable primary care physician” in their area.

“Like most seniors, Ann Lorenz relies on Medicare as she copes with serious health care challenges, including Parkinson's Disease. Ann sees a number of doctors and depends on a variety of prescription drugs and therapies to stay independent.

She worries that Obamacare threatens her access to doctors, treatment options and insurance plans and her neurologist shares her concerns."

http://youtu.be/B7MSRtsafG0

“Obamacare does not address physicians’ most pressing concerns, such as tort reform, and it worsens the already painful problems with third-party payment and government red tape.”

President Obama has also ignored the states’ pleas.

Governor Mitch Daniels of Indiana has been a leader in health care reform. He has made a lot of progress in reforming healthcare in Indiana. Obamacare is going to destroy his progress in healthcare reform.

Governor Daniels is speaking out and urging his fellow governors to take a serious look at the threat posed by Obamacare.

http://youtu.be/oRwgzDnMGlw

Individual practicing physicians are trying to stimulate public uprising through the media with minimal success.

Dr. Marc Seigel reported that 74% of doctors will retire, work part-time or quit if Obamacare takes effect.

This is not what Pelosi and Obama promised.

http://youtu.be/tsQJcK6QpGk

Politicians do not ask physicians and physicians do not have a powerful representative. Physicians are never included in the healthcare policy discussions.

Physicians are going to have to figure out a way to get their patients to get President Obama’s attention.

Here is one idea: Physicians could give their patients a list of talking points that patients could broadcast to their email and Facebook friends.

All of these patients and their friends could be instructed to send these talking points to their local newspapers, their congressmen and President Obama.It would make everyone aware of how physicians feel about Obamacare.

You can help your physician be heard!

Heightening public awareness usually gets politicians to rethink their destructive policies. Obamacare is one such a destructive policy.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

Please have a friend subscribe

Permalink:

Why Obamacare Will Not Work

April 4, 2012

inMedicine: Healthcare System

• Leave a comment

Stanley Feld M.D.,FACP,MACE

If Obamacare’s mandate is declared unconstitutional by the Supreme Court, the Obamacare’s nightmare for the future of medical care in America is over quickly.

If the Supreme Court declares Obamacare constitutional, it will not take a long time for Obamacare to fail on its own.

Obamacare will fail because it is out of touch with the needs of the primary stakeholders (patients and physicians).

Obamacare does not address some of the big problems causing the healthcare system to be so expensive.

It does not cure the healthcare insurance industry’s exorbitant administrative fees or administrative waste.

President Obama’s healthcare reform plan has ignored dealing with tort reform to help solve the practice of defensive medicine.

It does not provide reasonable incentives to for physicians to be innovative. It does not provide incentives for patients to be responsible consumers of healthcare.

The Accountable Care Organizations shared savings is too risky, too complicated and unreliable. It does not address consumers’ responsibility for adhering to treatment plans.

Primary stakeholders do not need and most do not want to be dependent on and controlled by a central government. Consumers want freedom of choice. Consumers do not want unelected officials making choices for them.

President Obama is using the wrong strategies in developing policies to Repair the Healthcare System. He is telling participants what has to be done. He should be providing incentives to get stakeholders to enthusiastically do the right thing.

Obamacare has already produced hundreds of thousands of pages of new regulations and constructed a costly bureaucratic structure that is guaranteed to be wasteful and inefficient.

The delays in implementing proposed programs attest to the fact that stakeholders are not interested in being forced into these programs.

President Obama’s deadlines have passed and been extended for Accountable Care Organizations, implementation of meaningful use EMR, ICD-10 coding conversions, 5010 billing requirements, chronic disease management implementations, pay for performance pilots and health-insurance exchange delays just to name a few.

All these delays are not only costly but they indicate a passive resistance to these programs. The media has not put these facts together for consumers.

Recently, the Congressional Budget Office (CBO) reported that Obamacare would increase the deficit more than one trillion dollars over the next ten years rather than saving $500 million dollars as Obamacare originally scored by tricky accounting. A McKinsey study reported that Obamacare would generate an even greater deficit.

I believe these deficit estimates are low compared to the eventual real cost. The increased Medicare costs of baby boomers is going to send the deficit out the roof. Medicare is unsustainable in its present form. Medicare must become an incentive driven program.

Otherwise Medicare will disappear completely for all seniors..

Why is this happening? President Obama is charming man and a good talker. The media is a gullible listener.

The media has refused to connect the dots for the American public. They have also not reported many of the dots toward failure.

I believe the media really has bought into President Obama’s disinformation campaign. It believes he is doing the right thing.

A close inspection of President Obama’s programs show nothing has worked so far. All of his pilot programs have failed to this point.

I have shown in past blog posts that either the programs are wrong or the designs of his pilots are faulty.

The public is waking up to President Obama’s phony accounting and manipulated budgets.

People are waking up to real causes of the dysfunction in the healthcare system that Obamacare is not addressing. They are starting to understand that the secondary stakeholders add little value to their care. President Obama’s Healthcare Reform Act does not attack the abuse of the secondary stakeholders.

The bottom line is Obamacare is a failed concept. It is going to greatly increase our deficit and hasten America’s path to insolvency.

I believe the basic underlying problem, which is not being address, is that none of the stakeholders in the healthcare system want to be serfs under the central control of the government.

The government has to find a way to put control of consumers’ health and healthcare destiny in the consumers’ hands.

Government’s job should be to help consumers become educated buyers of healthcare. Government should not make consumers’ healthcare choice for them.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

Please have a friend subscribe

Permalink:

It Is All about How You Look At Things

February 1, 2012

inConsumer Driven Health Care, Information Technology in Healthcare, Medicine: Healthcare System

• Leave a comment

Stanley Feld M.D.,FACP,MACE

My son Brad Feld wrote in response to my blog“How Software Innovation Can Cause Creative Transformation Of The Dysfunctional Healthcare System”,

Outstanding blog post dad.

And I think your punchline is completely correct – the healthcare software innovators should focus 100% of their energy on the patient and the physician (their customer). That would quickly transform everything in the healthcare supply chain.

Can you imagine what would happen if the government subsidized Borders and Barnes & Noble? Yup – pretty easy to see that they'd be doing fine and "bookstores would be classified as a public good." What nonsense.”

Healthcare policy makers are trying to reform healthcare using a defective business model.

The business model of 1945 to 1965 was a model that put the patient and physicians in the center of care.

Post Medicare in 1965 the business model changed because lots of government money came into the healthcare system. The secondary stakeholder began to devise ways of taking that money out of the system before and after the money was spent on direct patient care.

The relationships between patients and physicians became distorted. A giant hairball of vested interests by secondary stakeholders came between the patient physician relationships.

Well-intended policy makers tried to fix the system by making revisions and updates to a broken business model.

These revisions only made the healthcare system more expensive and less effective in the care of patients.

The 2011 business model is a jumble. The secondary stakeholders control the healthcare system and interfere with the patient physician relationship.

President Obama’s healthcare reform law is making the healthcare system worse. It is pasting regulations and restrictions on top of a failed business model.

It does not consider a way to get back to the effective business model of 1945-1965 for the 21^st century.

It reminds me of Microsoft and Windows. Microsoft is pasting revisions on top of the DOS operating system of the 1980s rather than revising the operating system.

Obamacare has added complexity to the system. There are many bad ideas such as Accountable Care Organizations and pay for performance rules to name just two. It does not deal with tort reform or patient responsibility for their own care and their own healthcare dollars.

Rather than pushing the secondary stakeholders to the edges of the healthcare system, Obamacare gives these stakeholders increased control over patients and physicians and destroys the patient physician relationship.

The critical turn is necessary now.

The 2020 business model of Obamacare will increase the velocity of healthcare system collapse. The result will be an increased budget deficit. Healthcare spending can escalate beyond GDP in 40 years.

At this critical turn we must go in a sustainable future state direction. The business plan must be exchanged with a completely new business model. The new business model must be unrestrained by the present business model.

This is where software innovation comes in. Software must be built that redirects the model to a consumer driven healthcare system.

It has been a disaster for the government, healthcare insurance industry and hospital systems to control the healthcare system.

It must be controlled by consumer choice, responsibility and actions with consumers owning their healthcare dollars. Legislation must be written to provide consumers with choice, responsibility, and incentives for compliance.

Consumers are the only ones that can demand this option. Consumers changed the course of SOPA and PIPA. Consumers can change the course of healthcare.

The secondary stakeholders will not give up their power easily. It will only come as a result of the Internet and innovative software that teaches consumers about their power.

Steve Jobs did it with iTunes, iPods, iPhones and iPads. Apple is about to do it with TV. Jeff Bezo did it with Amazon and the publishing industry.

The 2020 business model in the future state must have the following advocates, software developers, healthcare policy wonks, CEO’s of large corporations and small businesses. Most importantly, people 20-50 years old who are ell must start becoming engaged now so they can have a viable healthcare system when they get older. All these groups must think about the future state without present government restrictions. Steve Jobs did it for Apple. It can be done for healthcare.

The components of the future state should be,

The Ideal Medical Savings accounts,
The Ideal Electronic Medical Record,
Patient Responsibility for their care and healthcare dollars,
Patient education as an extension of physicians care
A team approach to chronic disease management with the patient becoming a professor of their disease, the team leader and the physician the coach with his healthcare team assistant coaches,
Tort Reform
Integration of specialty care.

All of these components must be executed at the same time. Consumers must be taught to drive the system.

Skeptics who are try to hold on to power and protect the validity of past policies will fight hard just as the music industry, the publishing industry and the movie industry have.

In the end the skeptics will realize the virtues of Pareto efficency. All the healthcare industry secondary stakeholders will thrive, as the patient physician relationship once again will be revitalized.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

Please send the blog to a friend

Permalink:

Some Innovative Software Opportunities In Medicine.

January 25, 2012

inChronic Disese Management, Consumer Driven Health Care, Healthcare Insurance Industry, Information Technology in Healthcare, Medicine: Healthcare System

• Leave a comment

Stanley Feld M.D.,FACP,MACE

I have pointed out that all the stakeholders are to blame for the dysfunction of the healthcare system.

I have also explained the difference between the healthcare system and the medical care system.

In the past two weeks I have explained that both the medial care system and the healthcare system are ripe for disintermediation with innovative software just as the publishing system was dis-intermediated with amazon.com, the music industry with ITunes and the movie industry with Neflix.

John Goodman has recently written a series of articles on how physicians are trapped by the current healthcare system.

The core problem has developed over the last 40 years. The government and the healthcare insurance industry have created a huge payment hairball between patients and physicians.

ICD and CPT coding has created complications beyond belief for patients and physicians. The ICD 10 is more confusing that ICD 9.

ICD 9 contained 15,000 codes. ICD 10 contains 68000 codes.

Instead of closing the window for fraud and abuse it has opened it further.

The problems with coding can be dis-intermediated by innovative software with its focus on patients and physicians.

A retired physician wrote the following note to me after reading my posts about innovative software and the destruction of the patient-physician relationship. His narrative was in response to the WSJ article “Should Physicians Use Email to Communicate With Patients?”

The writer is a retired physician with 40 years of private practice experience. He has lived through the development of the dysfunction in the healthcare system.

“Stan

This observation has been on my mind for a long time. The health issues in the 4th section of the WSJ today January

23,2011 caused me to put the ideas down on paper.

D”

“In doctors’ offices all across the country, a scenario like this is being played out as I write these comments.

The patient has a complaint, the physician listens (or not), performs an examination (or not) makes a decision regarding the probable cause of the complaint, writes a prescription (or two, or three), offers some instructions regarding what the patient should be doing to help himself (or herself), says goodbye and asks that the patient return at some future date for reassessment (or not).”

This is an excellent description of the disconnect between the care of patients by physicians. Patients and physicians should have a relationship where patients are at the center of the physicians’ healthcare team. The physicians are coaches. The physicians’ team is the assistant coaches helping physicians treat patients.

“What happens next is where I’d like to spend a little time in this essay.

The written prescription/s may be hand-carried to the pharmacy, the doctor may telephone the prescription/s to the pharmacy, or more commonly these days, the prescriptions may be sent on line or by fax, with the doctor’s assistant doing the sending.

The government is now paying an incentive bonus to the physicians for e-prescriptions. Unfortunately 60% of physicians’ offices cannot afford the software.

This is a place for a fully functional ideal electronic medical record in the cloud.

“Now here is where the situation can get dicey. Up to 20% of all those prescriptions are never picked up by the patient. After an interval, they are returned to stock in the pharmacy. It is unlikely that the doctor will be made aware that this has happened.”

The e-prescription must be a two way street. The physician should be notified electronically by the pharmacy if a patient does not pick up a prescription.

The physician’s office should automatically contact the patient and explain the importance of the medication.

Other results can also happen. The patient picks up some, but not all of the prescriptions because of the cost versus what he/she can afford.

In the fully functioning EMR software can be included to enable the pharmacy to inform the physician.

Or the patient picks up all of the medications ordered. Once at home, the patient may or may not take the medications as prescribed.

The instructions from the doctor may be recalled incompletely or inaccurately.

The healthcare team can electronically reinforce instructions and goals for the medication using the Internet sites picked by the physician.

The physician’s healthcare team must be an extension of the physician’s care.

Freestanding organizations will fail if they are not an extension of physicians’ care.

The CBO recently revealed that President Obama’s pilot studies using freestanding chronic disease management organizations have failed to lower the cost of care.

My fear is that President Obama and his healthcare administrators will conclude that chronic disease management does not lower healthcare costs.

Effective chronic disease management of diabetes can lower the complication rate by at least 50%. Decreasing complications can lower the cost of care by 80%

The medications may not be tolerated by the patient, and as a consequence, he/she may elect to discontinue one or more of them, or may elect to take them in some manner other than as directed by the doctor.

The patient may not notify his physician of his difficulty taking the medication.

Social networking between physicians and patients and patients in that physicians practice could solve this problem.

Patients understand that most cognitive physicians are reimbursed for coded procedures. Advice over the telephone or email is not reimbursed. A mechanism for reimbursement must be developed for using social networking.

The medications may prove effective in alleviating the problem that caused the patient to see their physician in the first place, or they may not.

Most of the events described will not be known to the patient’s physician until the patient is next seen in the office, and maybe not even then.

E-mail could have malpractice liability in the current malpractice environment. This is one more reason Tort reform is essential.

In a perfect world, a lot of the issues raised above could be made better by a few simple moves. The pharmacy could make the physician’s office aware that the prescriptions were never picked up.

Someone in the physician’s office could call or email the patient 3-4 days after the visit, and inquire whether the patient is taking the medication,

Reinforcing the physician’s instructions, and inquiring whether the medications are helping the patient, asking if there have been any problems arising from the use of the medication, and passing what is learned back to the physician.

The reinforcement of the instructions can be very helpful, and the awareness of issues relating to the medication can lead to more timely resolution of problems the patient is experiencing.

It has always seemed to this writer that the doctor-patient relationship would be well served if we all started to use what I call “The Doctor Phil Question”, which goes like this: “How’s that working out for you?”

It is all about patients’ responsibility for their healthcare and their healthcare dollar. It is about consumer driven healthcare and the patient physician relationship.

As long as the government and the healthcare insurance industry continues to drive a wedge between the patient and physician the cost of healthcare will continue to rise.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

Please send the blog to a friend

Permalink:

How Software Innovation Can Cause Creative Transformation Of The Dysfunctional Healthcare System

January 14, 2012

inInformation Technology in Healthcare, Medicine: Healthcare System

• Leave a comment

Stanley Feld M.D.,FACP,MACP

Joseph Schumpeter (1883-1950) begins his “The Theory of Economic Development“ with the idea of circular flow.

“If any innovations and innovative activities are excluded you end with a “stationary state.”

Schumpeter's theory is that “the success of capitalism will lead to a form of corporatism. In turn corporatism will foster values hostile to capitalism. He contends this is especially true among “intellectuals.”

The intellectuals and the social climate must allow entrepreneurship to thrive. If not capitalism will be replaced by socialism in some form.”

The hero of his story is the entrepreneur.

We are seeing this now as corporations are trying desperately to hold on to their power using obsolete technology and suppressing entrepreneurship with the government’s help.

“There are a couple of bills (like PROTECT IP and Stop Online Piracy Act) coursing through Congress that if enacted threaten the entire Internet only to protect outmoded business models of the movie and music industries.

The Internet has provided people with information, a choice and a voice. It has stimulated entrepreneurship and the current software revolution.

The government is making a big mistake in attacking freedom. I do not think it will get away with it because of the power of the Internet.

The hero of my story about "Repairing the Healthcare System" will be the software entrepreneur.

Technology has caused legacy business models to be replaced by innovative software models. These innovative software models have reduced costs and provided more choice for consumers at a cheaper price.

Everyone agrees that healthcare costs are out of control and are unsustainable. The corporate takeover of healthcare and medical care is leading to the inability of physicians to relate to and treat patients as patients should be treated.

The healthcare system is heading toward collapse. Obamacare is hastening the collapse as President Obama tries to work his way toward a socialized medical system.

America cannot afford socialized medicine. A paradigm shift must take place. This shift will occur as a result of innovative software. The challenge is who will get there first.

Britain, Canada and Europe’s socialized medical systems are failing financially. These countries are changing their healthcare systems from government controlled socialized systems to private systems.

Entitlement healthcare systems do not work because patients are not responsible for their healthcare dollars. Patients overuse the system because they are not responsible for payment.

When governments are overextended financially they restrict access to medical care.

Secondary healthcare stakeholders are fighting to maintain the “stationary state” because they receive 90% of the healthcare dollars.

Secondary stakeholders use a hollow excuse for maintaining control over the healthcare dollars. They maintain that consumers are too stupid and too powerless to take care of themselves.

Software companies are trying to improve the healthcare system. They have failed because they are focused on the wrong customers.

Secondary stakeholders are a giant hairball between the patient/ physician relationship. This hairball must be disrupted.

Much of the software necessary to disrupt the hairball is available. It is not focused for the benefit of patients and physicians.

An innovator is going to come along and disrupt this hairball just as Steve Jobs disrupted the music industry.

Dis-intermediating software can only become viral and effective if it enhances the patient physician relationship.

Consumers are starting to realize that they must become responsible for their own medical care and control their healthcare dollars. The government is too unreliable.

Patients are the customers/consumers of heaslthcare. Consumers must learn to manage their health and medical care dollars wisely. They must be provided with education and financial incentives to become responsible for their own health and healthcare choices.

What are the areas in which innovative software can dis-intermediate the failing structures in the healthcare system?

Ideal Electronic Medical Record.
Ideal Medical Saving Account.
Chronic Disease Management.
Tort Reform
Patient Education as an Extension of Physicians Care.
Integrated Care Between Family Practitioners and Specialists.
Patient Responsibility: Health and Healthcare Dollars.
Consumer Driven Healthcare.

No one likes to be forced to do anything. President Obama’s Healthcare Reform Act is forcing patients and physicians to do things they do not understand or do not approve of. Americans are refusing to buy into his system.

In the words of the great singer/philosopher Leonard Cohen, ”Everybody knows.”

“Over the next 10 years, the battles between incumbents and software-powered insurgents will be epic.”

A software innovator with a prepared mind between the age of 20-50 years old is going to come along and initiate a software revolution in healthcare. It will improve medical care for all. It will decrease healthcare costs and increase patient satisfaction. It will restore the patient physician relationship.

I will be happy to help anyone who will listen.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

Please send the blog to a friend

Permalink:

Where Is The Healthcare Money Going?

November 27, 2011

inDisinformation and the healthcare system, Physician's Problems, Politicians,Healthcare and Vested Interests

• Leave a comment

Stanley Feld M.D.,FACP, MACE

In reviewing Ezekiel Emanuel’s New York Times article I thought of an interesting question. In Dr. Emanuel’s view it is not worth having tort reform or healthcare care insurance reform. He claims these reforms are an insignificant burden to the cost of the healthcare system.

I have demonstrated that the evidence for tort reform and reform of the healthcare insurance industry proves him wrong.

The question then is where is the $2.5 trillion dollars the U.S. healthcare system spends going?

President Obama and Dr. Emanuel think it is going to physicians. President Obama’s idea to control healthcare costs is to reduce physician reimbursement.

Physicians have the weakest expression of its vested interests among all the stakeholders because of lack of effective leadership.

Simple arithmetic reveals that reducing physician reimbursement will yield an insignificant reduction in healthcare costs.

Never the less on January 1^st Medicare is going to decrease physicians’ reimbursement by 27%. This decrease is the result of the application of the government’s Sustainable Growth Rate (SGR).

The Sustainable Growth Rate (SGR) is a complicated and defective formula intended to contain the overall growth of Medicare spending for physicians’ services. The intent was to keep physicians’ reimbursement in line with the nation’s ability to pay for that medical care. The SGR formula uses the gross domestic product per capita in a complicated and inaccurate way.

In 2008 the Bureau of Labor statistics published a report that there were 661,400 physicians in the United States.

The report’s findings are summarized in the table below.

Projections data from the National Employment Matrix
Occupational Title	SOC Code	Employment, 2008	Projected Employment, 2018	Change, 2008-18		Detailed Statistics
Occupational Title	SOC Code	Employment, 2008	Projected Employment, 2018	Number	Percent	Detailed Statistics
Physicians and surgeons	29-1060	661,400	805,500	144,100	22	[PDF]	[XLS]
NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter onOccupational Information Included in the Handbook.

Let us assume that 161,400 of the 661,400 physicians in the U.S. work in private medical related industries such as the healthcare insurance industry, the pharmaceutical industry, the physician executive industry and government services. These physicians are not involved in direct patient care and do not generate direct patient costs to the healthcare system.

The number of non direct patient care physicians is probably higher (185,192 in other non practice positions and 476,208 in direct patient care). My assumption uses 500,000 physicians involved in direct patient care for all types of insurance to inflate physicians’ reimbursement.

The Bureau of Labor report states,

Physicians and surgeons held about 661,400 jobs in 2008; approximately 12 percent were self-employed. About 53 percent of wage–and-salary physicians and surgeons worked in offices of physicians, and 19 percent were employed by hospitals. .

Let us also assume that physicians’ overhead is 50% of total collections. Therefore physicians’ take home salary is 50% of collections. Fifty percent is a fairly accurate assessment whether the physicians are self employed or hospital system employed.

“According to the Medical Group Management Association's Physician Compensation and Production Survey, median total compensation for physicians varied by their type of practice. In 2008, physicians practicing primary care had total median annual compensation of $186,044, and physicians practicing in specialties earned total median annual compensation of $339,738.”

If we round off the salaries to $190,000 for Primary Care Physicians and $340,000 for Specialists and round off the number of Primary Care Physicians to 300,000 (actually 375,000) and 200,000 in Specialties (actually 125,000) and do the math, physicians’ salary comprise only 5% of the total $2.5 trillion dollars spent in the healthcare system.

The Math:

$190,000 per year per primary care physician x 300,000 physicians= $57,000,000,000 ($57 billion dollars for primary care physicians).

340,000 per year per specialists x 200,000 specialists= $68,000,000,000 ( $68 billions dollars a year for specialists).

$57 billion + $68 billion= $125 billion per year for the costs of physicians salary for direct patient care.

$125 billion (125,000,000,000)/ $2.5 ($2,500,000,000,000) trillion per year = 5%

If you double the physicians’ collections to include physicians’ overhead costs , physicians receive 10% of total dollars spent on healthcare system.

Improvements can be achieved in decreasing physicians’ overhead by having more integrated healthcare systems. Presently, most communities do a fair job.

Integrated electronic medical records could achieve a further decrease in the 5% of the total healthcare cost spend by physicians for overhead.

The government is spending billions of dollars on building bureaucracies, creating regulations, developing a IRS physicians fraud squad and creating committees trying to reduce 5% of the healthcare costs.

President Obama is approaching the problem of escalating healthcare system costs using the wrong premises. It will result in increasing healthcare system costs. Obamacare already has increased the costs of the healthcare system even though it is not fully implemented.

"IF REALITY DOESN'T match your expectations, perhaps it's time to re-examine your premises."

Where is the other 90% of the healthcare system costs going?

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

Please send the blog to a friend

Permalink:

Disinformation Compliments Of The New York Times

November 13, 2011

inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust

• Leave a comment

Stanley Feld M.D.,FACP,MACE

If you want to have an accurate opinion you should have accurate facts.

Lately, the New York Times has been publishing opinion articles, in the name of truth, by experts who give opinions based on inaccurate facts.

The danger is that government policy based on those opinions is wrong and will lead to unintended consequences.

Ezekiel Emanuel M.D. published such an article in his weekly opinionator blog on November 3^rd,2011.

I will review the facts used by Dr. Emanuel to form his opinion.

“Everyone — conservative and liberal — agrees that $2.6 trillion a year is too much to spend on health care, and that we have to cut costs. But they don’t agree on who is to blame or what is to be done.”

I agree.

He proposes an artificial threshold of significant costs saving in order to form a policy.

“ A useful threshold for savings is 1 percent of costs, which comes to $26 billion a year. Anything less is simply not meaningful.”

This number is random. It permits him to dismiss problems that cost the healthcare system less than $26 billion dollars a year.

Health care spending in the United States typically increases by about $100 billion per year. Cutting a billion here or there from something that large is undetectable is meaningless. In health care, you have to be talking about tens of billions of dollars before you are talking about real money.

He defines the divide between conservatives’ and liberals’ opinions.

He states that conservatives are concerned about the cost of tort reform. Liberals are concerned about the profits of the healthcare insurance industry and drug industry. Using the wrong data to prove his point he concludes that these issues are simply a distraction from the real efforts of controlling healthcare costs.

Nothing could be further from the truth.

Today, I will concentrate on examining his evidence against the need for tort reform.

“ Conservatives favorite fix is to reform medical malpractice by limiting noneconomic damages, statutes of limitation and lawyers’ fees. In its favor is the fact that doctors’ fear of medical malpractice lawsuits is legitimate.

According to a recent study in the New England Journal of Medicine, about 7.4 percent of doctors get sued each year. By age 65, even those in “low risk specialties” like pediatrics and dermatology face a 75 percent chance of being sued.

His argument continues by saying,

It’s no wonder doctors order M.R.I.’s for routine headaches and monthly ultrasounds for normal pregnancies, despite these procedures not being required or recommended by professional guidelines.

His second argument against tort reform is the Congressional Budget Office 2009 scoring of the cost impact of tort reform.

“In 2009, the Congressional Budget Office did a comprehensive assessment of the potential cost savings from medical malpractice reforms.

Its conclusions: A package that included a $250,000 cap on noneconomic damages, a $500,000 cap on punitive damages and a one-year statute of limitations for claims by adults would save about $11 billion a year — 40 percent from reduced malpractice premiums and the rest in the form of fewer defensive procedures like M.R.I.’s.

Dr. Emanuel concluded that $11 billion dollars a year savings is insignificant because it is a cost saving below $26 billion dollars a year. He contends tort reform is a distraction from real efforts to control healthcare costs and should be ignored. The CBO scoring information has lead Dr. Emanuel to an inaccurate opinion.

The CBO did not score all the necessary data to arrive at the accurate cost savings from tort reform.

“A full accounting of medical malpractice reforms shows the benefits would be $242 billion a year.”

The CBO assessment is a gross underestimate of the potential cost savings. President Obama and the Democrats provided the CBO with scoring data. The data given was intended to give cover to congressional Democrats who say malpractice-liability costs are trifling.

The truth is a full accounting reveals that more than 10 percent of America's health expenditures per year are spend on tort liability and defensive medicine.

The percentage of healthcare costs is even greater when the Massachusetts Medical Society survey is taken into account. The amount spent for defensive medicine can be extrapolated to actual costs from this survey.

I have written a series of blogs analyzing the impact Massachusetts Medical Society’s survey. The extrapolated costs turn out to be about $700 billion dollars a year. The real cost of defensive medicine is somewhere between $242 and $700 billion dollars a year.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-part-2.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-part.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-par.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-part-2.html

In 2008 damage awards alone for medical malpractice claims reached $5.9 billion dollars. The total of medical tort costs was $16 billion for legal costs, underwriting costs and administrative expenses. From 1986 the average jury award was $100,000. In 2006 the average award increased to $637,000. No one knows what the award value is for cases settled out of court.

Each year, 25% of practicing physicians are sued. 90% of physician sued are found innocent. The average defense cost is $100,000. This cost is not included in the CBO scoring

The fear of lawsuits causes most doctors to practice "defensive medicine" as the interviews of Massachusetts physicians points out. The result is unnecessary testing, referrals, and procedures to protect themselves from allegations of medical negligence.

A recent survey of doctors published in the Journal of the American Medical Association found that 93% of physicians admit to practicing defensive medicine. A 2008 survey by the Massachusetts Medical Society found that about 25 % of medical procedures are defensive in nature.

This waste results in increased healthcare insurance premiums. The premium increases result in an increase of at least 3 million uninsured people per year. When these uninsured people get sick they avoid going to a physician. This results in a decrease in work productivity. It is estimated that the annual decrease in productivity is more than $40 billion dollars a year.

In states where tort reform has been instituted by placing caps on so-called non-economic damages, the malpractice costs have decreased 39%. This drop in costs is a result of decreased malpractice suits. The decrease is economically bad for the plaintiff attorneys. Annual malpractice premiums have gone down at least 13%. In fact, the medical malpractice business for plaintiff attorneys has about dried up in Texas.

As a result of tort reform in Texas, more than 16,500 physicians have moved to the state from non-tort reform states. More than 430,000 additional Texas have healthcare insurance as a result of the tort reforms according to the Perryman group.

Senate Majority Leader Harry Reid, a Nevada Democrat, claims: "The whole premise of a medical malpractice 'crisis' is unfounded." Harry Reid listens to Dr. Ezekiel Emanuel’s opinion.

The influence of the disinformation is terrifying. Inaccurate opinions by influential people will never lead to a functional, affordable healthcare system.

The disinformation concerning healthcare insurance company profits and drug company profits will be discussed shortly.

The New York Times needs a fact checker.

In my view it is irresponsible of President Obama and his advisors to distort the truth with disinformation.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

Please send the blog to a friend

Permalink:

How To Manage Complexity?

September 25, 2011

inChronic Disese Management, Consumer Driven Health Care, Information Technology in Healthcare, Medicine: Healthcare System, Stakeholder Mistrust

• Leave a comment

Stanley Feld M.D., FACP, MACE

Complex systems are the result of interactions of experiential learning system and complicated learning systems. Complicated learning systems are created by scientific innovation. Managing the interaction effectively results in efficiencies and success.

On November 11,2007 I wrote about Mechanism Design and the Healthcare System. This Economic Theory won the Noble Prize that year. Few people have ever heard of the theory of Mechanism Design.

Many of the stakeholders in the healthcare system have some excellent ideas. I would include Dr. Donald Berwick and President Obama on that list. Problems usually arise from conflicting ideology and method of managing the complexity of competing ideologies.

The key is to align all the stakeholders’ vested interests in a fair and equitable way. It is important for all the stakeholders to agree with the method of managing the complexity created.

It is important to start a sensible discussion on how to Repair the Healthcare System. President Obama has a very difficult time the forcing adaption of his plan to Repair the Healthcare System because of conflicting ideologies.

The managing of the healthcare system and it many complicated parts have to be approached in a different way.

The key question should be who is the healthcare systems customer?

The people are the customer. President Obama’s believes the central government is the customer.

Consumers and physicians believe President Obama’s Healthcare Reform Plan is punitive. President Obama has disregarded their views.

I wrote in 2007,

“Last month the Nobel Prize in economics was awarded to Leoid Hurwicz, Roger Meyerson and Eric Maskin . They were awarded the Nobel Prize for developing the economic theory of “Mechanism Design.” My first reaction was “what is that?”

After some research I realized the power of Mechanism Design. It is a brilliant economic theory that could solve many of our economic problems. Mechanism Design applied to our healthcare system could solve most of the dysfunction.

What is it? “ In economics, mechanism design is the art and science of designing rules of a game to achieve a specific outcome, even though each participant may be self-interested.

Everyone in a free country tries to defend his/her vested interest. It is noble to defend the vested interest of others. Unfortunately, it does not work in reality. Rules can be constructed to serve all the stakeholders vested interest with consumers being the key stakeholder.

Setting up a structure in which each player has an incentive to behave as the designer intends does this. The game is then said to implement the desired outcome. The strength of such a result depends on the solution concept used in the game. It is related to metagame theory, which is the theory of games the playing of which consists of developing the rules of another game.

This is a complex thought. If the rules of the metagame are impossible to comprehend, follow or are total opposed to the participants’ vested interest the fallback position is the rules of the first game.

Mechanism designers commonly try to achieve the following basic outcomes: truthfulness, individual rationality, budget balance, and social welfare.

This should be the goal of everyone in a rational society.

However, it is impossible to guarantee optimal results for all four outcomes simultaneously in many situations, particularly in markets where buyers can also be sellers

A rule to the advantage of the seller can be a disadvantage to the buyer. The stakeholders need to figure out an appropriate tradeoffs.

Thus significant research in mechanism design involves making trade-offs between these qualities.

The tradeoffs can be reasonable. They must be shown to be to the advantage of all the stakeholders.

Other desirable criteria that may be achieved include fairness (minimizing variance between participants' utilities), maximizing the auction holder's revenue, and Pareto efficiency. More advanced mechanisms sometimes attempt to resist harmful coalitions of players.”

Pareto efficiency can be understood in the following graphic.

In essence when stakeholders are fighting neither B or C neither wins nor achieves total victory. The result is approximately position A. If managing complexity can convince both B and C they would be better off in position D the system has aligned incentives. Both are better being at position D.

“Looking at the Production-possibility frontier, shows how productive efficiency is a precondition for Pareto efficiency. Point A is not efficient in production because you can produce more of either one or both goods (Butter and Guns) without producing less of the other. Thus, moving from A to D enables you to make one person better off without making anyone else worse off (rise in Pareto efficiency). Moving to point B from point A, however, is not Pareto efficient, as less butter is produced. Likewise, moving to point C from point A is not Pareto efficient, as fewer guns are produced. A point on the frontier curve with the same x or y coordinate will be Pareto efficient.”

Lodi Hurwicz contributed the idea of incentive compatibility. His point is the way to get as close to the most efficient economic outcomes is to design mechanism in which everyone does best for himself or herself. He says this can be achieved by sharing information truthfully (Price Transparency). It is easy to understand that some people can do better than others by not sharing information or lying.

Truthful information (Price Transparency) is a huge issue in the healthcare system. Hospital systems, physicians, drug companies, pharmacies, the healthcare insurance industry and the government hide behind the opacity of information.

There is a mutual distrust among stakeholders.

This mutual distrust must be overcome and price transparency achieved before any progress can occur.

Everyone claims they are afraid to be sued because of regulations. Tort Reform and regulation simplification is a must for price transparency.

If everyone’s incentives are aligned you have a much more efficient economic system. An example is defense contracting. If you agree to pay on a cost plus basis you have created incentive for the contractor to be inefficient.

I you agree to pay a fixed price you can come close to an efficient price if you have all the truthful information. If you do not you have a fixed price and price transparency with incentives aligned, you create the incentive to be overcharged.

The fixed pricing in healthcare must be flexible for all stakeholders. All the variables cannot be controlled during a disease process.

The variables are the patient’s responsibility for their own care, the skill of physicians to guide that patient's care and the ability to communicate information (Technology/ electronic communication) with patients and other stakeholders to increase the efficiency of the first two variables.

Most people can do better by not sharing truthful information. If the rules of the game require truthful information you can get close to an efficient market driven solution.

At present there are several impediments to ideally increasing efficiency. In fact, the incentives are present to decrease efficiency. There are numerous examples where central control has not increased efficiency.

Patients are the consumers of healthcare. Consumers must drive the healthcare system. This is the only way to maximize efficiency.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

Permalink:

Does Medicare Have The Claims Data To Get The “Crooks”?

September 18, 2011

inDisinformation and the healthcare system, Information Technology in Healthcare, Medicine: Healthcare System, Stakeholder Mistrust

• Leave a comment

Stanley Feld M.D., FACP,MACE

I have opposed Medicare’s use of claims data to evaluate the quality of medical care. Quality medical care is the goal that must be achieved. However, no one has described the measurement of quality medical care adequately.

Physicians recognize when other physicians are not performing quality medical care. Physicians recognize when another physician is just testing and performing procedures to increase revenue.

These over testing physicians are a small minority of physicians in practice.

Quality medical care is not about doing quarterly HBA1c’s on patients with Diabetes Mellitus. Quality medical care is about helping patients control their blood sugars so their HbA1c becomes normalized. It is about the clinical and financial results of treatment.

The clinical and financial results depend on both patients and physicians. Patients must be responsible for managing their intake of food, exercise and medication. Physicians are responsible for choosing the right medication at the most cost effective prices and teaching patients how to control their intake and their exercise. This can be accomplished by a team approach with the physicians Diabetes Management team. The patient must be at the center of the team.

Medicare’s medical claims data does not provide this connection of the clinical information with the financial information.

I am not opposed to the use of claims data in identifying physicians, hospital systems and hospice or home healthcare organizations potential fraud. Potential fraud can be spotted by medical claims data by recognizing outliers.

The Wall Street Journal, in conjunction with the nonprofit Center for Public Integrity, attempted for nearly a year to obtain a Medicare database, the Carrier Standard Analytic File. The database contains 5% of all beneficiaries, and includes all doctor claims that Medicare paid directly in association with their care.

It focuses on doctors and others paid on a fee-for-service basis.

The Journal and CPI wanted the data at no cost under the freedom of information act. The government wanted $100,000 for eight years of data. The Wall Street Journal and the Center for Public Integrity sued the government for the data.

The Journal and CPI obtained the requested data at a substantially reduced price and agreed not to name individual physicians or patients.

The government lost a lawsuit to the AMA in 1979 and had been required to keep secret monies paid to individual physicians by Medicare. The AMA has continued try to defend this ruling,

The government is not barred from revealing the monies paid to hospitals, hospices or home healthcare agencies. This information about hospital, hospices and home healthcare agencies is difficult to come by.

Former House Speaker Newt Gingrich has been screaming for years that the database should be public as long as patients’ and physicians’ identity is kept confidential. "Our estimate is that the federal government, in Medicare and Medicaid alone, loses between $70 billion and $120 billion a year to crooks. You ought to be able to identify those."

"It's very hard to defend ignorance and willful hiding of data in the 21st Century,"

Newt Gingrich estimates that physicians are the biggest crooks in the system. If we lived in a price transparent ecosystem, we would be able to tell if he is correct. It would be important to know which stakeholder (physicians, hospitals, hospices, and home healthcare organizations) abuses the system the most.

The Wall Street Journal and the Center for Public Integrity in studying the database made available to them found government records suggesting one family practitioner in New York City collected more than $2 million in 2008 from Medicare.

According to experts who have examined her records, her pattern of billing strongly suggests abuse or even outright fraud, She consistently performed wide array of expensive tests that suggests she has been overcharging and over testing.

The procedures included polysomnography sleep analyses, nerve conduction probes and needle electromyography procedures. She is a doctor of osteopathy certified in family practice as well as hands on treatment called “manipulative therapy."

Eighty-nine percent of her patients received 29 tests. Fifty-six per cent of her billing came from these 29 tests. 13.1 procedures cost $2,048 each. The antifraud authorities have flagged her for special scrutiny.

I found something strange about these numbers. Medicare only allows a certain number of dollars for certain tests. Medicare does not reimburse the tests that are not approved for certain diseases. I do not know anything about “manipulative therapy” except that it is an alternative therapy that is based upon manipulation and/or movement of one or more parts of the human body

I assume that Medicare approved this therapy and approved the charges for these tests since Medicare paid for them. Procedures and laboratory tests must be correlated with approved diagnoses. This physician might have a large manipulative therapy practice doing approved testing. She has figured out a system to generate a good return within the rules of the system.

The real issue should is not discussed. Did Medicare make a mistake in approving payment for this treatment and these tests? If so, the tests and treatment should not be approved nor paid for by the government.

The physician administrators at Medicare who approve these tests, procedures and treatments are sharp people. They use evidence-based medicine to make reimbursement decisions.

There are reasons to suggest there is more to this story than meets the eye.

Never the less it is an example of how the Medicare outcomes medical database can be used to discover outliers. After the outliers are discovered, appropriate investigation must be done to discover why the physician is an outlier.

The real problems to be solved are ending the added cost of defensive medicine through tort reform and ending the additional costs of retesting by physicians and hospitals. .

President Obama has done nothing to decrease these billions of dollars in additional cost that add little value to patient care.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

4
5
6
7
8
9
10
7/13