Medical Care And Bureaucrats
Stanley Feld M.D.,FACP,MACE
The larger the bureaucracy the more inefficient a system becomes. Several things can happen in the decision making process.
1. The decision making process can become opaque rather than transparent.
2. Decisions are made by a committee by consensus.
3. Consensus committee decisions might not sharply define the original goals.
4. Blame for errors gets dissipated.
5. Decisions are only as good as the information that is gathered.
6. Changing a wrong decision can be difficult and costly.
President Obama’s healthcare reform law is creating 256 new agencies to gather information and recommend decisions for other agencies to write regulations.
The following decision is being made by an agency in Washington state. It is not only the wrong decision, but is a decision that will set back the care of Type 2 Diabetes Mellitus 15 or 20 years. It is a decision being made using the wrong information.
Ironically, the chairperson of the agency (the Health Technology
Assessment Group) is being promoted to head President Obama’s Patient-Centered Outcomes Research Institute as a reward for her good work in the state.
The Health Technology Assessment group’s actions are one of many warning signs for future tragedies of government controlled healthcare.
The subsidized, mandated and overregulated insurance model is imploding in Massachusetts yet the Secretary of Health and Welfare in Massachusetts last week announced it was a success.
In 2006, the state of Washington created the Health Technology Assessment group. The group scrutinizes the cost-effectiveness of various surgeries and treatments. Last week the panel presented its conclusions on lack of value of home glucose monitoring (HGM) for diabetic children under 18.
The board is targeting a fundamental standard of diabetes care. Home glucose monitoring has been well established as a cornerstone of diabetes care for three decades. The agency is wasting its time scrutinizing home glucose monitoring’s cost effectiveness. It has made a decision to eliminate the state’s insurance coverage on the basis of the wrong information. HMG is cost effective because its use decreases long term complications of diabetes.
The issue of cost effectiveness of a test deserves far more scrutiny. “ObamaCare” and the economic stimulus package have devoted billions of dollars to comparative effectiveness research.
President Obama has so often said; "The idea is to pit Treatment X against Treatment Y and find out "what works and what doesn’t." In theory, it sounds great. The Health Technology Assessment in Washington State is an example of how comparative effectiveness will work in the real world, as the political system tries to find ways to restrict or limit treatment to control entitlement spending with little regard for long term outcomes.
I have many ideas on how to control entitlement spending. Eliminating HMG is not one of them.
What is revealing is last November, Ms. Hole-Curry and others debated whether patients were the institute’s "primary constituents."
I believe these bureaucrats believe the budget deficit is their prime constituent. The Health Technology Assessment board is looking to decrease costs short term. Remember the oil filter advertisement, “Pay now or pay more later.”
In 1993, the Diabetes Control and Complication Trial (DCCT) showed that normalizing the blood sugar decreased the incidence of complications of diabetes. The complications of diabetes account for 80% of the cost of diabetes care. It takes 10 to 20 years to develop diabetes complications after the onset of the disease. Complications can be reduced at least 50% with glucose control.
The American Association of Clinical Endocrinologists’(AACE) system of intensive diabetes self- management teaches patients how to control their blood sugars. The system teaches patients how to adjust medications based on HGM readings.
Home glucose monitoring is a major tool used by patients to control their blood sugars.
It is ridiculous for an agency to discuss the efficacy of home glucose monitoring. By discontinuing payment for home glucose monitoring the group shows a disregard for medical science and its ability to prevent the complication of this devastating disease.
The 11-member Health Technology Assessment does not include an endocrinologist or any other physician with relevant clinical experience whose expertise is in diabetes.
“More to the point, as shown by the arbitrary Washington state method, political comparative effectiveness is not about informing choices. It is really about taking away options.”
Washington’s Health Technology Assessment makes the decisions about state-subsidized health care for 750,000 people including Medicaid beneficiaries, public employees, and prisoners.
The Health Technology Assessment program targets therapies that it thinks may be wasteful or unnecessary, and then in nearly all cases it proceeds to ban or restrict state payment for those treatments.
Since 2006, the Assessment program has eliminated coverage for or imposed restrictive conditions on drug-coated cardiac stents, knee replacements for osteoarthritis, ultrasounds for pregnant women, infusion pumps for chronic pain medication, lumbar fusion back surgery and hip resurfacing arthroplasty to name a few.
The Health Technology Assessment program is the prototype for ObamaCare’s many comparative effectiveness programs. No one is discussing the healthcare insurance industry abuse, bureaucratic waste, or decreasing access to care.
President Obama has already hired Ms. Hole-Curr, head of the Health Technology Assessment program to head his comparative effectiveness program
President Obama’s healthcare reform act will create de facto criteria for procedures through his comparative effectiveness program. The result will be to dictate all the choices about how doctors are allowed to treat patients.
This is not “evidence based medicine.” Anyone can believe prove anything if they evaluate the wrong information. If the government’s imperative is to save money, new and effective tests and treatments will be rationed to the detriment of patient care.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.