Stanley Feld M.D.,FACP,MACE

Why will President Obama’s Healthcare Reform Plan fail? Medicare and Medicaid have unrelenting increases in its yearly deficits. Both programs as well as the available private health insurance do not provide incentives to consumers or physicians to improve the healthcare system.

Consumers, who have healthcare insurance have been passive until now. “If I get sick my insurance will take care of me.”

As more people get sick they realize they are uninsured.

Therein lies the problem with President Obama’s Healthcare Reform Plan. It forces the consumer to be dependent on the government rather than to be responsible for health and healthcare.

Sometimes patients cannot help it if they get sick. Some illnesses are genetic. Some illnesses are environmental. Many illnesses are preventable.

Healthcare reform should put an emphasis on disease prevention. It should provide incentives for consumers to prevent disease and incentives for physicians to teach patients to avoid complications once they have a chronic disease.

Prevention of the onset of chronic disease and the complications of chronic disease require motivated consumers. It also requires the elimination of environmental hazard that precipitate chronic disease. There are many examples of environmental hazards (air pollution, toxic wastes, cigarette smoking, and obesity to name a few).

Let us take obesity as an example.

Is there any language provided in any of the bills before congress addressing the obesity epidemic?  No, yet obesity predisposes consumers to Type 2 Diabetes and coronary artery disease. Medical care of these two problems cost the nation $400 billion dollars a year.

In a March 26, 2008 article in the New York Times, New York City was declared Fat City? Ten (10) million pounds were gained in 2 years according to the April issue of Preventing Chronic Disease, a medical journal published by the Centers for Disease Control and Prevention.

“About 173,500 adult New Yorkers became obese and more than 73,000 received new diagnoses of diabetes from 2002 to 2004, according to a new study by the New York City Department of Health and Mental Hygiene. Put another way, “the citywide weight gain totaled more than 10 million pounds in just two years,” the city noted in a news release summarizing the study.”

President Obama should be concentrating his efforts on how to motive people to lose weight in order to avoid the onset of Diabetes Mellitus and Heart Disease. He and his healthcare reform team should study my “War on Obesity.”

None of the necessary steps are being taken by the administration to solve Obesity in America. Without a solution to the obesity epidemic, the Type 2 Diabetes Mellitus epidemic will continue and the cost of President Obama’s new entitlement plan will escalate.

How should President Obama motivate people to be responsible for their own care? He should provide incentives. He should propose and enforce regulations that provide consumers with a healthier food environment.

A first step would be to deal with farm subsides that encourage obesity. It can be done. He must also provide effective education to the public to combat obesity. He must provide economic incentives to consumers to exercise and lose weight. This can be accomplished by the ideal medical savings account.

President Obama should become serious about dealing with malpractice reform. The cost of defensive medicine is $750 billion /year. Consumers must be educated to demand tort reform. Defensive medicine would affect the remaining balance in their medical savings accounts. Consumers should be taught to demand an explanation for the tests from their physicians. Consumers could be taught to waive physicians’ liability if there is no good reason for a test. Physicians have not been sued for tests they have done. They have been sued for tested they have not done.

President Obama should be spending money on a system that encourages innovation (the ideal medical savings account) rather than spending and wasting money on a new entitlement for a healthcare system that is broken.

I will repeat my answer to your question. Your employer or the government pays for your ideal medical savings account.  The entire policy (the $6,000 deductible and the $6,000 high deductible policy) remains tax deductible to your employer.

You have the responsibility to use the first $6,000 wisely and remain healthy. If you do not spend it you keep it in a trust account tax free for retirement and not for future healthcare needs. If you use it before you retire you pay ordinary income tax plus a penalty. If you spend more than $6,000 you receive first dollar healthcare coverage.

If you are self employed and qualify for government aid or a subsidy the government pays for healthcare premium. If you are on Medicaid the government remains the payor.

All citizens would have the same healthcare coverage. Everyone would be responsible for their choice of lifestyle. President Obama would instantly have 300 million consumers repairing the healthcare system. It would take major control of the healthcare system out of the healthcare insurance industry’s hands.

Stimulating innovation would decrease the cost of healthcare while insuring everyone. It would improve wellness and quality care.

Expanding an entitlement is not the answer to Repairing the Healthcare System.

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

Stanley Feld M.D.,FACP,MACE

I agree with the general goals of healthcare reform as outlined by President Obama. They are universal healthcare, affordable healthcare, and quality healthcare. The problem is the route he is taking will not achieve his goals.

His route will increase bureaucracy, decrease freedoms of individuals to choose, decrease quality and increase the cost of care.

A reader question highlights the confusion about the ideal medical saving account.

“ Do I understand you expect me to pay $500 per month toward tax free trust account and also budget $500/month for medical expenses toward my deductible?

How does a person making under $28,000 year do this!

The answer to the question is no.

The government or your employer would pay the $500 per month for you into a trust account. This would put the first dollar coverage in consumers’ hands rather than the healthcare insurance industry’s hands. The trust account would serve as an economic incentive for consumers to become wise shoppers for medical care and for them to be responsible for their own wellness. What was not spent of the first $6,000 would be in consumers’ retirement account rather than in an account for future healthcare expenditures.

Consumers would force providers to be innovative and compete for the consumers’ healthcare dollars just as Wal-Mart, Target, and Amazon do. Government’s position should be to provide appropriate consumer education to protect them and become informed shoppers for their healthcare needs.

There are several new innovative practice and healthcare insurance systems being developed by physicians that will reduce the cost of care by marginalizing the healthcare insurance industry’s influence and control over the healthcare system while reducing physician overhead.

I will discuss some of these innovative practice and healthcare insurance systems in the near future.

President Obama is willing to spend 1 trillion dollars over the next ten years to repair the healthcare system in addition to the many billions President Obama has secured in the hastily prepared “economic stimulus package.” It is money that will be wasted because his healthcare reform package can only increase healthcare complexity and decrease access to care. It will also increase the healthcare industry’s profit at the expense of medical care to consumers.

Consumers should be motivated to be in charge of their healthcare needs and expenditures. President Obama’s healthcare team thinks a large and inefficient bureaucracy will do it. He has only to look at the failed system in Massachusetts.

Everyone agrees that Medicare and Medicaid have failed. Seniors, in general, are satisfied with Medicare coverage until they have to pay all the deductible costs.

Some are able to cover the deductible costs with additional insurance (Medigap or Medicare Advantage) coverage. The premiums for Medicare are high with the upper limit for full coverage being $15,000 a year. The cost of the Medicare premium is not noticed because it is taken out of their social security payment.

The premiums with coverage for deductibles and drugs can vary from $3,000 per persons to $7,500 per person with after tax dollars. Seniors are all means tested by direct communication between the IRS (tax returns) and Medicare.

Despite high premiums the government has to subsidize healthcare costs at an unsustainable rate. New innovative delivery of healthcare is essential in order to deliver healthcare at an affordable cost, universally, and with increased quality.

Expanding the Medicare system to all citizens will simply make the deficit worse. The CBO estimates that in 40 years the yearly deficit will increase by 100 trillion dollars with the present healthcare system.

There are ways to accomplish President Obama’s goals. The system has to be simplified. Consumers have to be in control of their healthcare dollars and be responsible for their health. President Obama’s healthcare reform plan will make consumers more dependent on government and healthcare more expensive.

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

Stanley Feld M.D.,FACP,MACE

The New York Times wrote an editorial “Medicare Scare-Mongering.” The editorial contained no facts proving its proposition.

“It has been frustrating to watch Republican leaders posture as the vigilant protectors of Medicare against health care reforms designed to make the system better and more equitable.”

Both Democrats and Republicans know that Medicare is unsustainable in its present form. Both parties are posturing for the public and political power. Neither are attacking the problems in the healthcare system to make the system sustainable.

Why? Repairing the healthcare system threatens the vested interests of secondary stakeholders that fund politicians’ election.

“ This is the same party “Republicans” that in the past tried to pare back Medicare and has repeatedly denounced the kind of single-payer system that is at the heart of Medicare and its popularity.”

Both parties are trying to pare back Medicare because Medicare is unsustainable. Each party’s methodology is different.

“For all of the cynicism and hypocrisy, it seems to be working. The Republicans have scared many older Americans into believing that their medical treatment will suffer under pending reform bills.”

Seniors have evaluated the Democrat’s proposals. They understand the implications of the various proposals. Seniors are convinced that the implications are going to have a negative impact on their present level of care. They mistrust the political rhetoric and understand bureaucratic inefficiency. .

“The general public believes that, too. The latest New York Times/CBS News poll of 1,042 adults found that only 15 percent believe changes under consideration would make the Medicare program better, while 30 percent think they would make it worse.”

It would be very simple for the New York Times editorial board to explain how the Democratic proposals would improve Medicare coverage. The editorial does not do this. It is more rhetoric.

“The Obama administration and Congressional leaders are hoping to save hundreds of billions of dollars by slowing the growth of spending in the vast and inefficient Medicare system that serves 45 million older and disabled Americans.

If Medicare is inefficient, how is the administration going to do to make it efficient? It cannot do it by increasing bureaucracy. 

The Obama proposals are ignoring the two most wasteful aspects of Medicare, defensive medicine and the healthcare insurance industry’s abuse of outsourced administrative services.

The inefficiency in Medicare will only increase when the government controls healthcare coverage of an additional 45 million people.

There is only one logical way for the government to reduce costs. It must ration care. Reducing Medicare payments by $500 billion dollars over the next few years is not going to decrease bureaucratic inefficiency.

The editorial also complains about Medicare Part D and Medicare Advantage. Both programs were terribly constructed. They rip off both patients and the government. Complaining about them and throwing money at them will not make them more efficient. Medicare Advantage must be eliminated and Medicare Part D must be redone in a logical way and not to the advantage of the healthcare insurance industry.

“by enhancing their drug coverage, reducing the premiums they pay for drugs and medical care, eliminating co-payments for preventive services and helping keep Medicare solvent, among other benefits.”

Why isn’t the editorial board attacking the healthcare insurance industry that is making billions of dollars from Medicare Part D at the government’s expense? Why isn’t the NYT editorial board demanding that the government negotiate the same drug price it pays for military and veterans administration drugs?

The House legislation, the only bills in near-final form, would reduce and ultimately eliminate a gap — the so-called doughnut hole — in Medicare drug coverage that currently forces more than three million beneficiaries to pay for drugs entirely out of their own pockets once they hit specified spending levels.

It will create a great government deficit.

Republicans are not the villain. The current proposals are the villain. The proposals will restrict access to care, ration care, and waste $1.1 trillion dollars on top of the yearly loss presently.

But the Republicans have done far too good a job at obscuring and twisting the facts and spreading unwarranted fear. It is time to call them to account.

The New York Times editorial board does not present a stitch of evidence for the statement below. I think liberals are so tired of the senseless debate that they will accept any declaration.

What the Republicans aren’t saying — and what the Democrats clearly aren’t saying enough — is that in important ways, coverage for a vast majority of Medicare recipients, those in traditional Medicare, should actually improve under health care reform.

The New York Times editorial board is clearly pro Obama and has done a poor job analyzing the content of the proposals.

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

Stanley Feld M.D.,FACP,MACE

The Canadian Healthcare system does not offer us a better option. We are told Canadians are happy with their system. However, only 20% of the potential patients use the system at one time. When Canadians need Immediate care they often come to the U.S. and pay cash for their treatment rather than face the lines resulting from rationed care.

“*Canada has one-third fewer doctors per capita than the OECD average. "The doctor shortage is a direct result of government rationing, since provinces intervened to restrict class sizes in major Canadian medical schools in the 1990s," Dr. David Gratzer, a Canadian physician and Manhattan Institute scholar, told the U.S. House Ways & Means Committee on June 24.”

Many Canadian physicians have come to the United States to practice medicine in the last 20 years.

“ Some towns address the doctor dearth with lotteries in which citizens compete for rare medical appointments”.

Massachusetts’ universal healthcare system has failed. In Massachusetts there is an overwhelming shortage of Primary Care Physicians. Patients are trading or selling physician appointments in many small towns.

Canada has the same horror stories. Eighty percent of Canadians are not sick. They feel their healthcare system is fine.

There are many deficiencies in Canada’s single party payer system that are not advertised by politicians in the U.S. that want a single party payer.

"In 2008, the average Canadian waited 17.3 weeks from the time his general practitioner referred him to a specialist until he actually received treatment," Pacific Research Institute president Sally Pipes, a Canadian native, wrote in the July 2 Investor’s Business Daily. "That’s 86 percent longer than the wait in 1993, when the [Fraser] Institute first started quantifying the problem."

* This includes a median 9.7-week wait for an MRI exam, 31.7 weeks to see a neurosurgeon, and 36.7 weeks – nearly nine months – to visit an orthopedic surgeon.”

These waiting times are rationing of care. Patients have sued the government and the Supreme Court ruled in favor of patients.

“ The Canadian supreme court justice Marie Deschamps wrote in her 2005 majority opinion in Chaoulli v. Quebec, "This case shows that delays in the public health care system are widespread, and that, in some cases, patients die as a result of waiting lists for public health care.”

The healthcare debate in the U.S. is not about improving the health of Americans. It is about shifting the control over the healthcare system to the government from the private sector.

If healthcare reform was about improving the health of Americans, our politicians would be focusing on how to decrease our mortality and morbidity rate due to the major chronic illnesses, how to decrease the abuse of the healthcare insurance industry, how to decrease the waste of defensive medicine, how to get people insured that are refused insurance with pre existing illness and how to give people incentives to keep themselves healthy.

These are the major issues. There is no need to have to take over the healthcare system. The government should make the rules, level the playing field in favor o the consumer, let the consumer drive healthcare and then get out of the way.

“The public option – for which Democrats lust – would fuel an elephantine $1.5 trillion overhaul of this life-and-death industry. Guess who goes home with the goodies?”

It is not the consumer. It will be the government bureaucracy, the healthcare insurance industry, and the pharmaceutical companies.

It will be the government having control over the public and its ability to choose its healthcare. It will increase government’s dominance over our lives and our freedoms.

Is this what Americans’ want?

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

Stanley Feld M.D.,FACP,MACE

The single party payer system in Great Britain and Canada is not as good as Democrats and the mass media have led us to believe. The United States pays more of our gross national product for its healthcare than Great Britain and Canada do but they do not get the same or better outcomes than we do.

The healthcare system in the U.S. could be repaired. The cost can be reduced significantly if the U.S adopted the changes I and others have advocated

The changes are significant malpractice reform, reduction in waste and abuse by the healthcare insurance industry, consumer driven healthcare through a medical savings account and the institution of a universal electronic medical record funded by the government and paid for by physicians and hospital systems by.usage

The sound bite of effective care given in Great Britain and Canada for less money is false. Here are just a few outcome comparisons between our healthcare system and theirs. You be the judge;.

• “Breast cancer kills 25 percent of its American victims; in Great Britain, the Vatican of single-payer medicine, breast cancer extinguishes 46 percent of its targets.”

Why? Early diagnosis with timely mammography and immediate and intensive treatment at the time of diagnosis.

“ Prostate cancer is fatal to 19 percent of its American patients. The National Center for Policy Analysis reports that it kills 57 percent of Britons it strikes.”

It is fatal in 19 percent of American males because of delayed diagnosis and treatment in some males. Males are not good about routine checkups. They go to the physician when they hurt. Some without insurance cannot afford to get a routine PSA screening test..

“ Organization for Economic Cooperation and Development data show that the U.K.’s 2005 heart-attack fatality rate was 19.5 percent higher than America’s. This may correspond to angioplasties, which were only 21.3 percent as common there as here.”

Why? The difference is caused by a delay in access to care.

“The U.K.’s National Institute of Health and Clinical Excellence (NICE) just announced plans to cut its 60,000 annual steroid injections for severe back-pain sufferers to just 3,000. This should save the government 33 million pounds (about $55 million). "The consequences of the NICE decision will be devastating for thousands of patients," Dr. Jonathan Richardson of Bradford Hospitals Trust told London’s Daily Telegraph. "It will mean more people on opiates, which are addictive, and kill 2,000 a year. It will mean more people having spinal surgery, which is incredibly risky, and has a 50 per cent failure rate."

It is not very smart or efficient to restrict access to care to end up with patients being addicted to narcotics and/or needing surgery that will be delayed because of restrictions on access to care.

"Seriously ill patients are being kept in ambulances outside hospitals for hours so NHS trusts do not miss Government targets," Daniel Martin wrote last year in London’s Daily Mail. "Thousands of people a year are having to wait outside accident and emergency departments because trusts will not let them in until they can treat them within four hours, in line with a Labour [party] pledge. The hold-ups mean ambulances are not available to answer fresh 911 calls. Doctors warned last night that the practice of ‘patient-stacking’ was putting patients’ health at risk."

Unintended consequences are usually the result of bureaucratic mandates. It is similar to the airlines leaving the gate to leave on time and then keeping us waiting on the tarmac for takeoff so that it looks good for on time takeoff statistics. It is not about service. It becomes about statistical targets to cover defects.

There are many more examples of defects in the National Health Service of Great Britain that we never hear about. The average person is not sick and does not complain about the healthcare system. Many are passive about the abuse they experience in the healthcare system.

President Obama’s healthcare team is going to create a Federal Healthcare Board similar to the NICE and have a panel of experts decide on best practices for Americans in order to improve our healthcare system.

When has a consensus committee ever improved anything? A consensus panel will eliminate individual freedom to make healthcare choices.

Is this what Americans’ want?

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

Stanley Feld M.D.,FACP,MACE

Both noise and facts drive decision making in all areas of policy making. The trick is to separate noise from facts. The devil is usually in the details. Americans have been conditioned to sound bites. We do not have the patience to understand the details and their ramifications.

Sound bites can be misinterpreted as being valid. The healthcare debate has made the public more interested in the details and the potential unintended consequences.

A typical example is the cost of care for Type 2 Diabetes Mellitus in Dallas compared to five Texas cities. The claims data is probably noise disguised as valid facts.

The public has become very cynical about the traditional media. Reporters can easily be manipulated by government and special interest groups’ press releases. Policy should be made for the benefit of the people. It should not be made for the benefit of special interest groups or the government.

The public mistrusts the government because of its discoveries of frequent disinformation fed to the media. This disinformation extends to all areas of its daily life including the two wars, the economic meltdown, the bank bailout, and automotive bailouts. All seem to be done at the expense of taxpayers and not to taxpayers’ advantage.

What doesn’t the public know about the healthcare debate? The public does not believe President Obama’s generalities. His plans contain too much bureaucracy, inefficiency, waste, taxes, and too much tax payer dollars. Special interests groups such as the healthcare insurance industry and hospital system will gain at the expense of the taxpayers and their freedoms.

The public is very hesitant to let the government take over the management of its healthcare. It mistrusts the government and its inefficiency. It knows something must be done to repair the healthcare system. However, it does not know what. President Obama’s plan sounds too convoluted, tricky and bureaucratic. His healthcare reform plan has little chance to be efficient and fair to the public.

Americans trusted President Obama during the election campaign. They are having their doubts now especially with the implications of his healthcare reform program.

The public trusts the healthcare insurance industry less than it trusts the government. .

The easiest way to accomplish healthcare reform is to allow consumers to control their healthcare dollar and teach them how to spend it wisely.

Both the public and the physician community are unhappy that 45 million people are uninsured and many more are under insured.

Qualifications for Medicaid depend on the definition of poverty. Most states and the federal government utilize the outdated 1995 definition of poverty. The definition disqualifies people who make more than $12,000 and less than $60,000 a year. If this group is self employed they cannot afford $14,000 a year for a private insurance plan with after tax dollars.

Some states have tried to increase the poverty level to permit more patients to qualify for Medicaid. The federal government has refused to supplement these states with increase Medicaid funding.

Physicians are under reimbursed by Medicaid. Therefore most physicians do not participate in the program. Physicians cannot make a living seeing Medicaid patients unless they create Medicaid mills and see 200 patients a day per physician using lots of patient extenders.

Newt Gingrich calls this Medicaid fraud. He has proposed fining these physicians or putting them in jail. This will only intensify the primary care physician shortage for Medicaid.

Another proposal hidden in the Baucus bill is to require all physicians to participate in all government programs.

Both of these Medicaid problems are easily fixed with correct regulation by the government without a costly bureaucracy resulting in unintended consequences..

Consumers who lose their jobs cannot afford Cobra insurance with after tax dollars. Consumers over 55 years old with a pre-existing illness, even if they wanted to pay with after tax dollars, would not qualify for private insurance.

Simple federal regulations can require insurability without a massive and wasteful bureaucracy.

The enemy is the healthcare insurance industry not patients or physicians. Patients and physicians are partly to blame. However, it is a response to the unlevel playing field created by the government.

The public is convinced that a government directed healthcare system will not protect or adequately insure them. Government healthcare reform will be inefficient. It will shift medical decisions away from patients and physicians.

President Obama does not seem to care about the opinions of the people who elected him. He is convinced that government control with a single party payer is the only system that will repair the healthcare system. He is doing everything he can to evolve the healthcare system into a single party payer system.

“The fact that America is even considering government medicine is equally wacky. The state guides health care for our two closest allies: Great Britain and Canada. Like us, these are prosperous, industrial, Anglophone democracies. Nevertheless, compared to America, they suffer higher death rates for diseases, their patients experience severe pain, and they ration medical services.”

The government and the pundits are telling us that we spend one third more for healthcare than other industrialized countries and do not have better medical outcomes.

I will discuss the myths about healthcare in the near future. President Obama and the Democrats are making healthcare reform decisions on the basis of the validity of these myths. They are convinced the only way to fix the healthcare system is to have the government control the healthcare system.

It makes no sense based on the experiences of others. We need only to review the disaster in Massachusetts as a result of unintended consequences.

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

Stanley Feld M.D.,FACP,MACE

I am a retired Dallas Clinical Endocrinologist who has no financial vested interest in this new report. I also was the chairman of the American Association Clinical Guidelines on the Treatment of Type 2 Diabetes Mellitus: A System of Care Of Intensive Self-Management of Diabetes Mellitus.

I am disheartened the lack of science that is presented as scientific information in this new study of claims data for Type 2 Diabetes Mellitus.

An article about the report was published in the Dallas Morning News on Thursday September 12, 2009. The article demonstrates how well intended people can be mislead by data that has little scientific or social scientific validity.

Misleading data can lead to inaccurate conclusions. Inaccurate conclusions lead to incorrect healthcare policies.

The federal and state governments as well as private industry rely heavily on medical claims data to make healthcare policy decisions. Medical claims data are derived from healthcare insurance industry’s computer systems. Claims data relate variables to each other and produce data.

The study reported in the Dallas Morning News relates the diagnosis of Type 2 Diabetes Mellitus to the average cost per Type2 Diabetic patient per year in five cities in Texas. There are many defect in the claims data because they do not consider the many confounding variables that might affect the conclusions (variables that can influence the data in one direction or another). Accurate conclusions cannot be derived from the data.

Healthcare policy makers have used similar inaccurate claims data to formulate healthcare policy for years. Inaccurate conclusions lead to incorrect healthcare policy. The new healthcare policy in turn distorts the dysfunctional healthcare system even further.

Well intended corporations want to help employees improve their health and healthcare coverage. However, they adopt incorrect policies that fail to achieve their goals and increases their healthcare costs.

“Dallas-area doctors charge more to treat patients with the most common form of diabetes than doctors in any other Texas city, according to a report set for release Thursday.”

“Doctors here charge an average of $6,992 annually per patient with Type 2 diabetes, compared with $2,079 in Austin, $3,067 in El Paso, $1,578 in Fort Worth and $2,226 in Houston. “

Let us assume these claims data are correct. The implication is in Dallas physicians charge more for the treatment of Type 2 Diabetes Mellitus than in the other major cities in Texas and do not do a better job of caring for Type 2 Diabetic patients. If you are going to get Type 2 Diabetes Mellitus don’t get it in Dallas, get it in El Paso. 

What is wrong with these claims data? What are the confounding variables and their effect on the conclusion?

1. Physicians in Dallas see Type 2 Diabetics more frequently and do more tests than physicians in other cities.

What is wrong with these claims data and what are the confounding variables.

One confounding variable could be that Clinical Endocrinologists in Dallas have been teaching Primary Care Physicians how to practice evidence based medicine for Diabetes Mellitus for years

Best practices for Type 2 Diabetes Mellitus dictates that patients are followed up 4 times a year.

HbA1c levels which measure the blood sugar control over 3 months should be done four times a year. A minimum of twice a year is acceptable in some guidelines. These criteria are adopted by the NCQA. NCQA will be President Obama “expert guideline panel.

Patients with Type 2 Diabetes Mellitus in the other cities might not see physicians as frequently. Some physicians see Diabetics once a year because the Diabetic is told they have a touch of Diabetes and follow up is not that important. Type 2 Diabetics are usually not symptomatic even if they are walking around with a high blood sugar.

However, high blood sugar levels cause micro and macro vascular disease leading to the complications of diabetes such as eye disease and blindness, kidney disease and renal dialysis, neuropathy or nerve disease, leg amputations and heart disease. High blood sugars increase cholesterol and LDL (bad cholesterol), low HDL (good cholesterol) and subsequent heart attacks.

All of these complications need to be monitored according to guidelines. Effective treatment intervention can stop the progression and even reverse the onset of complications.

1. The claims data might indicate that the physicians in other cities do not take care of patients with Type 2 Diabetes Mellitus as well as physicians in Dallas.
2.   It might also mean that despite physicians in Dallas following up patients and  practicing evidence based medicine patients do not comply with treatment recommendations resulting in expensive complication.

Physicians can do tests, see patients often, prescribe the correct medication and diet and patients still gain weight and have very high blood sugars and cholesterol levels. Patients must be responsible for their care between doctor visits.

3. In Dallas there might be more Obesity, Type 2 Diabetes, heart attacks and renal dialysis leading to a higher cost per patient per year than other cities despite physician effort.

None of this data is reflected in the claims data collected and compared. This is great deficiency of claims data.

We have claims data about physicians in Dallas. They do a higher percentage of HbA1c’s than physicians in other cities. They probably do a greater number also.

The implication is Dallas physicians should have a lower cost than other cities because a higher percentage of HbA1c’s. Patients should be better controlled and have less complications.

The HbA1c is simply a marker of blood sugar control. It does not decrease the complication rate. It should not be a measure of quality of care. If done once a year rather than four times a year it will decrease the cost of care. Lowering the HbAic should be the measurement of the quality of care. It will reduce the complication rate of Type 2 Diabetes. Claims data does not measure the improvement in HbA1c levels.

The complications of Type 2 Diabetes Mellitus consumes 80% of the healthcare dollars spent on Type 2 diabetes.

4. The majority of Type 2 Diabetes Mellitus is discovered in the CCU after a male has a myocardial infarction. These patients are expensive patients. They are included in the diabetes claims data.

5. Physicians in El Paso might not code for Type 2 Diabetes Mellitus in a patient with a myocardial infarction. We do not know this from claims data.

Claims data tell us nothing about the care of the patients. Yet health policy makers assume studies are valid. The only thing valid about this new report is that it was done. Claims data confuses health care policy makers and leads to wrong conclusions about the quality of care. .

"This confirms what we already know from other recent studies that medical charges in Dallas are among the highest in the country," said Marianne Fazen, executive director of the Dallas Fort Worth Business Group on Health.”

“The state average is $3,399 per patient with
Type 2 diabetes, the form of diabetes that occurs when insulin the body produces doesn’t work well enough to process sugar into energy. “

The treatment of Type 2 Diabetes Mellitus is a team sport. The physician should be the coach and the patient is the player. The patient has to be taught to be a professor of diabetes care. Physicians have to measure patients’ progress and help patients make adjustments to their care.

This new report is worthless. It does not shed any light on what needs to be done to prevent the complications of Type 2 Diabetes Mellitus nor improve the quality of diabetes care in Texas.

Once we abandon the notion that claims data can tell us something about quality of care we will start making progress to improve quality of care.

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