Attached you find a link to several interesting articles from the recent edition of Health Affairs about the medical information technology applications.
Data gathered in electronic health records on the experience of millions of patients have the potential to dramatically accelerate clinical research and provide the nation with timely, urgently needed knowledge about the value of new medical technologies, researchers report in a special edition of Health Affairs on "rapid learning" published January 26. Strategies for advancing rapid learning in health care was the topic of a Health Affairs-sponsored conference in Washington, D.C., today that included an appearance by AHRQ Director Carolyn Clancy, as well as several authors from the January 26 issue.
A webcast of the briefing is available at:
www.rwjf.org/newsroom/activitydetail.jsp?id=10195&type=3
The attached prologue accurately reflects on the content and purpose of the articles.
Yours
Bernd
http://content.healthaffairs.org/cgi/content/full/hlthaff.26.2.w107/DC2
26 January 2007
Rapid Learning:
Getting Technology Into Practice
PROLOGUE: Amid persistent concerns about performance and quality, the health sector remains ambivalent about electronic health records (EHRs). Champions of accelerated adoption of health information technology (IT) have been unable to generate a groundswell of demand, despite excellent arguments for health IT's potential to save money, improve quality, and transform care. It may be, though, that the strongest argument for speeding IT adoption is still largely below the radar.
The dramatic pace of biomedical innovation has dazzled America but created nagging tensions as well. Our insatiable demand for new drugs and technologies is driving unsustainable growth in health spending. An explosion of new knowledge has strained clinicians' learning capacity and fostered subspecialization and fragmentation of care. Clinical research and regulatory capabilities are swamped with urgent questions about the safety and effectiveness of new treatments.
But on scattered islands within the dominant system, promising approaches to managing innovation are beginning to surface, and their foundation is the EHR. In organizations such as the Veterans Health Administration (VHA), Kaiser Permanente, and the Geisinger Health System, the richness of data capture in fully deployed patient record systems is enabling clinicians and researchers to answer practical questions about safety, effectiveness, and cost more efficiently than the traditional process of randomized clinical trials (RCTs) possibly could.
The implications of these approaches for the future of "rapid learning" are spelled out in an overview paper by Lynn Etheredge. "An inadequate knowledge base limits initiatives to improve health system performance," Etheredge writes. "With large, computer-searchable databases, studies that would now take years will be doable, at low expense, in a matter of weeks, days, or hours." Case studies accompanied by commentaries explore how EHR database research is being used at the VHA (for diabetes research and care), Kaiser (for cancer research and care), and Geisinger (to close the "inferential gap" between RCTs and real-world clinical decisions). David Eddy offers his vision for a health system that will use predictive models from large, merged databases of EHRs to advance the biomedical sciences as well as clinical care. Sean Tunis and colleagues suggest strategies to use large new government clinical care databases to support Medicare coverage decisions, comparative effectiveness studies, and postmarket drug safety surveillance.
The rapid-learning efforts described here were originally presented at a March 2006 conference in Washington, D.C., organized by Etheredge and Health Affairs and sponsored by the Robert Wood Johnson Foundation. The publication of the papers is also supported by Kaiser Permanente and the federal Agency for Healthcare Research and Quality.
Sunday, February 04, 2007
Monday, January 15, 2007
Health Care Reform Ideas
Dear Friends and Colleagues:
Attached an article from todays Miami Herald and a response in the form of a Letter to the Editor.
============================================================================
Monday, January 15, 2007
Letter To The Editor
The interview with Brian Keeley, CEO of Baptist Health South, revealed a common misperception about how to solve America’s healthcare crisis. Locked into an ideological feud Democrats and Republicans either tout the benefits of a government-controlled system (Medicare For All) or the advantages of a free market system. Both sides are wrong.
Currently, local, state and federal government entities control 45% of all health care dollars spent and the number of uninsured is still rising, approaching almost one-third of all citizens in South Florida.
The so-called “free enterprise system” is riddled with mandates and regulations preventing an individual to obtain affordable insurance coverage and excluding those who suffer from even minor ailments.
A desired universal healthcare coverage should be based on the following:
1) Complete transparency and proper financial management of America’s domestic healthcare programs with full accountability of every tax-dollar spent;
2) Emphasis on prevention, individual choices and access to affordable medications;
3) Deregulation of the health insurance industry, removing insurance mandates and creation of an open national insurance market;
4) Comprehensive malpractice reform by establishing a medical court system and mandatory medical error reporting mechanisms, thereby guaranteeing the rights of patients and protecting the economic viability of the medical practitioner;
5) Creation of regional and national information sharing mechanism that allow for the immediate access to protected and safe guarded patient information, which will reduce the duplication of medical tests and avoid fatal medication errors.
America health care system is indeed in a deadly death spiral. We don’t need a Democratic or Republican solution. We need an American solution to provide health care for all.
Bernd Wollschlaeger,MD,FAAFP
Vice-President, Dade County Medical Association
16899 NE 15th Avenue
Miami,FL 33162
Phone: (305) 940-8717
============================================================================
Posted on Mon, Jan. 15, 2007
Reversing U.S. healthcare's 'death spiral'
Brian Keeley, head of South Florida's largest healthcare company, discusses what to do about the nation's health problems and his own firm's role.
BY JOHN DORSCHNER
jdorschner@MiamiHerald.com
Brian Keeley is a mix of big-time business executive, philosopher and social innovator.
As chief executive of Baptist Health South Florida, he has created over the past 20 years a strong nonprofit system of five hospitals in affluent southern Miami-Dade County and the Keys at a time when many stand-alone facilities were going under or being sold to for-profit chains.
The system has become South Florida's largest nongovernment employer, with more than 11,200 workers, and the region's biggest healthcare firm, with $1.5 billion in annual revenue and a net surplus of $136 million.
Even with all this success, Keeley is concerned about America's conflicting views of healthcare. He succinctly portrays the tensions this way: ``We all want the absolutely best care, and we want someone else to pay for it.''
Like many industry leaders, he is convinced the country's healthcare system is in a ''death spiral,'' because the number of uninsured keeps rising. These people tend to skip primary care and end up in emergency rooms, where they run up big bills that they frequently can't pay, meaning hospitals must charge private insurers more to make up for these losses. That tends to make private health insurance less affordable, causing more companies to drop coverage, increasing the number of uninsured, and so on.
At times a bubbly cheerleader for new ideas, Keeley has announced recently two major initiatives: Baptist Health South Florida will favor using vendors who provide health insurance for their employees and it plans to provide affordable housing to attract workers.
Q: America spends twice as much on healthcare as other industrial countries, but we have the same or shorter life expectancy. Do we spend too much?
A: Yes, America spends a lot, for various reasons. One is the demands of the American consumer, but also we have a highly fragmented, highly inefficient system. And we're the only one of those [industrial] countries without a national, single-payer system.
Q: Where is one area where we cut back on costs and not hurt healthcare?
A: I think the administrative overhead and the lack of any integrated medical record system is a huge opportunity. We have so much duplication because we have these little silos of information in each doctor's office and every hospital. And no one talks to each other, and so consequently when the physicians order things they have no idea what other doctors ordered.
If we could come up with a single electronic medical record system that everybody shared, in my estimation we could save trillions of dollars because everybody is accessing the same information. . . . Everybody has to share. I am an extremely strong advocate of this.
Q: America has 45 million uninsured. Give me a short take on how to get people covered.
A: You can take the Democratic approach -- universal health [insurance], government control. Or you can take the Republican approach -- the free enterprise system. I'm for the free enterprise system.
The system will not self-correct right now. The market forces aren't aligned to make it self-correct.
I love what Massachusetts is doing with the mandate [requiring employers to provide insurance]. They have less of a problem. Their uninsured is 6 to 8 percent. In Florida it's 19 percent and in South Florida it's approaching 30 percent. . . . California is similar to what they're doing in Massachusetts, maybe a little more aggressive. California has about 20 percent uninsured, so they're similar to us. . . .
But I love the idea of a mandate: If you're going to play in the arena, you have to provide health insurance, and if you don't, guess who picks it up? We do because there's a cost shift to the private sector [in which private insurers have to pay higher premiums to cover hospitals' costs for treating the uninsured], or they're put on Medicaid rolls and we pay through our taxes. So a mandate makes tremendous sense to me if we're going to operate under the free enterprise system.
Q: Hospital gross charges are often three or four times what private insurers or Medicare pays. Why not just do away with gross charges?
A: The complex gross charge structure is incongruent, incoherent, indefensible. I will not defend the way hospitals charge, but we don't control that because we have all these impositions that are brought down on us by the federal government, which by the way pays us two different ways for Medicare and Medicaid.
And then every managed care company decides at its own discretion that they're going to pay us differently.
If we had a uniform, single methodology for reimbursing hospitals and physicians, we could save a huge amount of money, but it's beyond our capability to force that upon these payers out there, because they're the ones who set the rules. And we need to make this consumer-friendly, especially as we have this major shift to consumer-driven healthcare.
Q: Baptist Health South Florida has a very healthy bottom line, and insurance companies say you charge too much. As a nonprofit, how would you explain your surpluses?
A: Yes, we do have a profitable operation. And we're mission driven. We're faith based. And what that means is every single penny gets pumped back into the community for the benefit of the community, through charity care, through community service, through building new hospitals, like Homestead, which nobody would ever build down there because we're still losing $7 [million] to $10 million in Homestead.
We're making a huge commitment over there and in West Kendall [where Baptist plans another new hospital]. So it's not going in anybody's pockets.
By having a strong bottom line, we can also give a significant amount of charity care. People are eligible for charity if they earn up to 300 percent of the federal poverty level -- in contrast to Jackson, where it's up to 200 percent.
Attached an article from todays Miami Herald and a response in the form of a Letter to the Editor.
============================================================================
Monday, January 15, 2007
Letter To The Editor
The interview with Brian Keeley, CEO of Baptist Health South, revealed a common misperception about how to solve America’s healthcare crisis. Locked into an ideological feud Democrats and Republicans either tout the benefits of a government-controlled system (Medicare For All) or the advantages of a free market system. Both sides are wrong.
Currently, local, state and federal government entities control 45% of all health care dollars spent and the number of uninsured is still rising, approaching almost one-third of all citizens in South Florida.
The so-called “free enterprise system” is riddled with mandates and regulations preventing an individual to obtain affordable insurance coverage and excluding those who suffer from even minor ailments.
A desired universal healthcare coverage should be based on the following:
1) Complete transparency and proper financial management of America’s domestic healthcare programs with full accountability of every tax-dollar spent;
2) Emphasis on prevention, individual choices and access to affordable medications;
3) Deregulation of the health insurance industry, removing insurance mandates and creation of an open national insurance market;
4) Comprehensive malpractice reform by establishing a medical court system and mandatory medical error reporting mechanisms, thereby guaranteeing the rights of patients and protecting the economic viability of the medical practitioner;
5) Creation of regional and national information sharing mechanism that allow for the immediate access to protected and safe guarded patient information, which will reduce the duplication of medical tests and avoid fatal medication errors.
America health care system is indeed in a deadly death spiral. We don’t need a Democratic or Republican solution. We need an American solution to provide health care for all.
Bernd Wollschlaeger,MD,FAAFP
Vice-President, Dade County Medical Association
16899 NE 15th Avenue
Miami,FL 33162
Phone: (305) 940-8717
============================================================================
Posted on Mon, Jan. 15, 2007
Reversing U.S. healthcare's 'death spiral'
Brian Keeley, head of South Florida's largest healthcare company, discusses what to do about the nation's health problems and his own firm's role.
BY JOHN DORSCHNER
jdorschner@MiamiHerald.com
Brian Keeley is a mix of big-time business executive, philosopher and social innovator.
As chief executive of Baptist Health South Florida, he has created over the past 20 years a strong nonprofit system of five hospitals in affluent southern Miami-Dade County and the Keys at a time when many stand-alone facilities were going under or being sold to for-profit chains.
The system has become South Florida's largest nongovernment employer, with more than 11,200 workers, and the region's biggest healthcare firm, with $1.5 billion in annual revenue and a net surplus of $136 million.
Even with all this success, Keeley is concerned about America's conflicting views of healthcare. He succinctly portrays the tensions this way: ``We all want the absolutely best care, and we want someone else to pay for it.''
Like many industry leaders, he is convinced the country's healthcare system is in a ''death spiral,'' because the number of uninsured keeps rising. These people tend to skip primary care and end up in emergency rooms, where they run up big bills that they frequently can't pay, meaning hospitals must charge private insurers more to make up for these losses. That tends to make private health insurance less affordable, causing more companies to drop coverage, increasing the number of uninsured, and so on.
At times a bubbly cheerleader for new ideas, Keeley has announced recently two major initiatives: Baptist Health South Florida will favor using vendors who provide health insurance for their employees and it plans to provide affordable housing to attract workers.
Q: America spends twice as much on healthcare as other industrial countries, but we have the same or shorter life expectancy. Do we spend too much?
A: Yes, America spends a lot, for various reasons. One is the demands of the American consumer, but also we have a highly fragmented, highly inefficient system. And we're the only one of those [industrial] countries without a national, single-payer system.
Q: Where is one area where we cut back on costs and not hurt healthcare?
A: I think the administrative overhead and the lack of any integrated medical record system is a huge opportunity. We have so much duplication because we have these little silos of information in each doctor's office and every hospital. And no one talks to each other, and so consequently when the physicians order things they have no idea what other doctors ordered.
If we could come up with a single electronic medical record system that everybody shared, in my estimation we could save trillions of dollars because everybody is accessing the same information. . . . Everybody has to share. I am an extremely strong advocate of this.
Q: America has 45 million uninsured. Give me a short take on how to get people covered.
A: You can take the Democratic approach -- universal health [insurance], government control. Or you can take the Republican approach -- the free enterprise system. I'm for the free enterprise system.
The system will not self-correct right now. The market forces aren't aligned to make it self-correct.
I love what Massachusetts is doing with the mandate [requiring employers to provide insurance]. They have less of a problem. Their uninsured is 6 to 8 percent. In Florida it's 19 percent and in South Florida it's approaching 30 percent. . . . California is similar to what they're doing in Massachusetts, maybe a little more aggressive. California has about 20 percent uninsured, so they're similar to us. . . .
But I love the idea of a mandate: If you're going to play in the arena, you have to provide health insurance, and if you don't, guess who picks it up? We do because there's a cost shift to the private sector [in which private insurers have to pay higher premiums to cover hospitals' costs for treating the uninsured], or they're put on Medicaid rolls and we pay through our taxes. So a mandate makes tremendous sense to me if we're going to operate under the free enterprise system.
Q: Hospital gross charges are often three or four times what private insurers or Medicare pays. Why not just do away with gross charges?
A: The complex gross charge structure is incongruent, incoherent, indefensible. I will not defend the way hospitals charge, but we don't control that because we have all these impositions that are brought down on us by the federal government, which by the way pays us two different ways for Medicare and Medicaid.
And then every managed care company decides at its own discretion that they're going to pay us differently.
If we had a uniform, single methodology for reimbursing hospitals and physicians, we could save a huge amount of money, but it's beyond our capability to force that upon these payers out there, because they're the ones who set the rules. And we need to make this consumer-friendly, especially as we have this major shift to consumer-driven healthcare.
Q: Baptist Health South Florida has a very healthy bottom line, and insurance companies say you charge too much. As a nonprofit, how would you explain your surpluses?
A: Yes, we do have a profitable operation. And we're mission driven. We're faith based. And what that means is every single penny gets pumped back into the community for the benefit of the community, through charity care, through community service, through building new hospitals, like Homestead, which nobody would ever build down there because we're still losing $7 [million] to $10 million in Homestead.
We're making a huge commitment over there and in West Kendall [where Baptist plans another new hospital]. So it's not going in anybody's pockets.
By having a strong bottom line, we can also give a significant amount of charity care. People are eligible for charity if they earn up to 300 percent of the federal poverty level -- in contrast to Jackson, where it's up to 200 percent.
Sunday, January 14, 2007
Doctor Faces Criminal Charges
Dear Friends and Colleagues:
Attached an article from today's Miami Herald reporting that a Miami-Dade heart surgeon facing criminal charges for perjury and fraud for allegedly exaggerating his qualifications about his experience doing open-heart surgery while giving a deposition for the plaintiff in a Michigan malpractice case, in which the federal government was the defense.
I personally know Dr. Zakharia and was saddened to hear that a dedicated surgeon faces such serious charges.
What can we learn from this case?
Yours
Bernd
Attached an article from today's Miami Herald reporting that a Miami-Dade heart surgeon facing criminal charges for perjury and fraud for allegedly exaggerating his qualifications about his experience doing open-heart surgery while giving a deposition for the plaintiff in a Michigan malpractice case, in which the federal government was the defense.
I personally know Dr. Zakharia and was saddened to hear that a dedicated surgeon faces such serious charges.
What can we learn from this case?
- Carefully prepare your testimony
- If in doubt do not guess, but answer " I have to get back to you"
- Be prepared that your entire performance records are discoverable and can be subpoenaed.
Yours
Bernd
| Posted on Tue, Jan. 09, 2007 |  |
| |
| COURTS Heart surgeon faces criminal charges In a rare move, a federal grand jury indicted a Miami heart surgeon for allegedly lying in a Detroit malpractice case. jdorschner@MiamiHerald.com Alex Zakharia, 68, a Miami-Dade heart surgeon for more than 30 years, is facing criminal charges in Detroit for perjury and fraud. The doctor was indicted by a federal grand jury, which alleged that he exaggerated his qualifications about his experience doing open-heart surgery while giving a deposition for the plaintiff in a Michigan malpractice case, in which the federal government was the defense. Zakharia told The Miami Herald on Monday that the defense lawyers didn't understand him, he didn't exaggerate and the issue of his experience wasn't even material to the central subject in the case, which he said involved botching the presurgery tests of a patient. ''They should be going after the doctors who did this to this veteran, instead of a doctor who gave his honest opinion,'' Zakharia said. He has hired a lawyer and hopes to have the case resolved shortly. The qualifications of doctor-witnesses are often challenged in hotly contested malpractice lawsuits, but officials of the Florida Medical Association and the Florida Justice Association, the new name for the state's trial lawyers group, could not immediately recall any other examples of doctors being criminally charged with misstating their qualifications. Many doctors testify against other doctors only in proceedings far from their own states, and the Florida Medical Association has been pushing the Legislature to pass a law licensing out-of-state medical witnesses so that juries can be sure of their qualifications. Trial lawyers have vehemently opposed the measure, which has repeatedly failed to pass. The charges against Zakharia were pushed by the U.S. Attorney's Office in the Eastern District of Michigan, which was also the office that provided the defense attorneys in the malpractice lawsuit, brought by a man whose last name was Rodgers against the Veterans Administration and the U.S. government. Zakharia said notes in the medical case file clearly indicated that, before the coronary bypass surgery, an ultrasound to detect blocked carotid arteries was inconclusive and needed to be redone. But new tests were not done before surgery. During his deposition in that case, Zakharia was asked by defense attorneys about his qualifications on coronary bypass surgery. The indictment alleges Zakharia testified he performed 10 to 12 such operations a year and was the lead surgeon during the operations. When defense attorneys said records of the hospitals he mentioned -- Cedars and Miami Heart -- did not support his claims, he said the hospital records were in error, the government alleges. Later, an attorney ''who had paid him thousands of dollars to testify as an expert witness,'' asked him about the discrepancies in his experience, and Zakharia continued ''to mislead the attorney concerning the extent of his surgical experience,'' the indictment alleges. Zakharia said Monday he participated in those surgeries, but he made his role clear to attorneys. ``I told them I'm not the lead surgeon. I assist.'' But the indictment includes a portion of a transcript: Q: ``When you say you are doing about 10 CABG procedures a year, are you the attending physician, the guy in the chest doing the sewing and cutting?'' A: Yes. I'm not including many cases where I assist or supervise other younger surgeons, you know.'' Q: ``You would be the man who signs the operative note?'' A: ``Yes.'' Zakharia said Monday he doesn't testify in many malpractice cases and maintains a full practice. He will turn 69 later this month. ''I'm held in very high regard,'' he said. ``I did five procedures and saw 16 patients today.'' | |
HealthCare Reform Plan in California
TOPIC: Health Care Reform in California
"But when you look at the math, they actually benefit. Everyone is left with a better deal,
even though everyone has to chip in." (Governor Schwarzenegger)
even though everyone has to chip in." (Governor Schwarzenegger)
Governors Schwarzeneggers bold healthcare reform proposal has triggered a wave of support and opposition.
Dear Friends and Colleagues:
I think its important to understand his proposal and to learn how to refine such an approach, so that it can achieve what it is supposed to achieve.
California now has about 6.5 million people who are uninsured or underinsured, a higher level than any other state. According to the Census Bureau, 15.9% of Americans lacked health insurance in 2005; in California, it was 19.4% ( in South Florida almost 30%!!).
The plan would require employers with 10 or more workers to provide health insurance or pay a 4% tax on all wages covered by Social Security: The plan would be financed by charging a "dividend" (i.e .TAX) of 2% on doctors' revenue and 4% on hospitals' and $10 billion to $15 billion in new money coming into the medical system from so many people being insured, as well as a proposed increase in the state's Medi-Cal plan.
Such a "tax", camouflaged as a "dividend", guarantees opposition from California physicians who already voiced their concerns.
David Henderson brings up a very important point; does universal coverage provided by the government work?
He raises two concerns:
"Why doesn't increased government power tend to solve the problem of the uninsured? There are two main reasons. First, when government provides health insurance, many people who take advantage of it drop their own privately provided health insurance. In a 1996 article in the Quarterly Journal of Economics, Harvard economists David M. Cutler and Jonathan Gruber found a 50% "crowding-out effect." As the federal Medicaid program expanded, for every two people who gained insurance through Medicaid, one dropped private health insurance. Although this is a net addition of one, the costs to taxpayers are much higher than expected because now half of the newly covered, instead of paying their own way as they previously did, become wards of the state.
Second, of the 46 million or so people without health insurance at any given time, about 45% will have health insurance within four months. This is one of the main findings of a 2003 study by the Congressional Budget Office, "How Many People Lack Health Insurance and for How Long?" That shouldn't be surprising in a country where most private health insurance is employer-provided and most unemployment spells last 11 weeks or less. Solutions that involve government mandates on employers or employees will, therefore, miss connecting with about half of the people who are uninsured at a given point in time."
Maybe Governor Schwarzenegger should consider the following:
1) Abolish or reduce government mandates, which have contributed to an increase in insurance premiums
2) Open the market place and let insurance providers from all over the US compete for customers, thereby allowing average citizens to buy health insurance in the same way as they currently can but car insurance.
Again David Henderson points out:
"In the last few decades, state governments, the main regulators of health insurance in the individual and small-group markets, have mandated coverages for many kinds of health care. According to the Council for Affordable Health Insurance (CAHI), a pro-market association of insurance carriers, there were 1,843 state mandates in 2006. Among the most common, and most expensive, mandates are chiropractic care, treatment for alcoholism and drug abuse, and mental health benefits. California's government mandates coverage for all of the above, as well as for many other benefits, including, for example, infertility treatment -- a very expensive benefit.
Abolishing these mandates would allow people who don't want to be covered for these things to buy cheaper insurance, while still allowing those who want them to buy and pay for them. Would such an approach work? That's like asking whether, if the government currently required new cars to have CD players, eliminating that requirement would lower the price of a car. Of course it would work.""
=====================================================================================
Schwarzenegger Embarks
On Fight for Health Plan
By JIM CARLTON
January 9, 2007; Page A2
(See Corrections & Amplifications item below.)
California Gov. Arnold Schwarzenegger proposed a sweeping plan to mandate universal health care in the nation's most-populous state, putting forth measures that would require employers to pay into the health-care system as well as tax hospitals and doctors to help offset medical coverage's spiraling costs.
The move makes Mr. Schwarzenegger, a Republican, the latest governor to try to tackle a problem -- covering the uninsured -- that the federal government has been unable to solve. Massachusetts Gov. Mitt Romney, who is seen as a Republican contender for the presidency, struck a bipartisan deal with his state's legislature last year mandating universal health care in the Bay State. Mandates for some employers to pay more of their share if they don't already have been passed in Vermont and Maryland, as well as New York City and San Francisco. Maryland's law was thrown out by a federal judge last year after a legal challenge.
California, with 36 million residents, could influence other states to follow suit. But Mr. Schwarzenegger also faces potentially one of the fiercest battles of his political career, because his plan calls for some level of sacrifice from many of the parties affected.
The governor anticipated criticism in his remarks yesterday to a Sacramento gathering of his staff and business executives, saying the long-term rewards of having lower medical costs would make the pain worthwhile. "It appears we are taking something away from everyone here," Mr. Schwarzenegger said by video link as he recuperated from a broken leg injury he suffered while skiing over the holiday break in Sun Valley, Idaho. "But when you look at the math, they actually benefit. Everyone is left with a better deal, even though everyone has to chip in."
The governor said his plan to charge a "dividend" of 2% on doctors' revenue and 4% on hospitals' would be more than offset by what his office estimates would be $10 billion to $15 billion in new money coming into the medical system from so many people being insured, as well as a proposed increase in the state's Medi-Cal plan.
California now has about 6.5 million people who are uninsured or underinsured, a higher level than any other state. According to the Census Bureau, 15.9% of Americans lacked health insurance in 2005; in California, it was 19.4%.
The Schwarzenegger plan drew some skepticism. "There may be some unintended consequences," said Joel Fox, president of the Small Business Action Committee in Sacramento, in a panel discussion organized by the governor's administration after the speech. "For example, will some businesses opt out of covering employees and go into the pool [of state-insured workers], thus overwhelming the pool? Will some companies cherry-pick their employees so that they hire those more easily covered, instead of guys like me that are older?"
Allan Zaremberg, president of the California Chamber of Commerce, questioned whether the plan would really make health care more affordable for those who already are insured. Mr. Zaremberg said the taxes on doctor and hospital revenues could be passed onto consumers and the companies that already provide insurance in higher premiums.
Others praised the plan. Officials of Blue Cross of California called it "bold and visionary," singling out the provision to provide medical coverage to all uninsured children in the state, even those of illegal immigrants. "Taking each part separately, there's something for everyone to hate, but taken as a whole, there's a lot to like," said Bruce Bodaken, chairman, president and Chief Executive of Blue Cross of California.
Some other business leaders, including the chief executive of California-based grocery titan Safeway Inc., are also backing the plan. One reason: They already pay to fund medical plans for their employees, and resent the competitors who don't. On balance, the governor likely will have a tougher time persuading members of his own party to back the measure than the Democratic lawmakers who control the California Legislature. Indeed, Mr. Schwarzenegger's plan isn't hugely different from versions recently proffered by state Senate President Don Perata and Assembly Speaker Fabian Nunez. Mr. Nuñez said in an interview that he just had a few issues with the governor's plan -- most important, that it would shift money from one program for the poor into this health-care program. "On its face, this is a good start," Mr. Nuñez said.
he California government could allow any Californian to buy health insurance from any willing insurer in any state and be subject to the regulations of that state. That way, people could shop for the degree of paternalism they want. If they want insurance from a state that requires many coverages, they could do so and pay the high premiums that result. If they want bare-bones coverage, they could do so also. The result would surely be that some of the current uninsured would buy insurance. Were I in the market for individual insurance and given the choice, I would not bother paying for coverage for alcohol or drug abuse.
---- Mark Golden contributed to this article.
======================================================================================
Terminatorcare
By DAVID R. HENDERSON
January 10, 2007; Page A17
MONTEREY, Calif. -- On Monday, Arnold Schwarzenegger presented his proposal for reducing the number of Californians who lack health insurance. His proposal is almost indistinguishable -- except in details -- from that of the Democrats who dominate the California Assembly and Senate.
The Democrats tend to favor solutions involving regulations, government spending and taxes, and Senate President Pro Tem Don Perata's proposal -- the main contending Democrat plan -- hits the trifecta. It would require employers to provide health insurance; give them the option of paying a tax instead of providing health insurance; and increase spending by expanding both the Medi-Cal and Healthy Families programs, which provide care to low-income children -- including children of illegal immigrants and the disabled.
[graphic]
Mr. Schwarzenegger's solution hits the trifecta also. He would require employers with 10 or more workers to provide health insurance or pay a 4% tax on all wages covered by Social Security: Look for employers with 10 to 12 employees to get creative about outsourcing. And look as well, as Harvard economist Jonathan Gruber has documented, for wages to fall in firms that offer health insurance because of the mandate. Gov. Schwarzenegger would throw in a 2% tax on doctors and a 4% tax on hospitals to help fund Medi-Cal, California's name for Medicaid. And he would expand Medi-Cal to adults earning as much as 100% above the poverty line and to children, even those here illegally, in poor and middle-income families. He hopes, by doing this, to shift $5 billion of Medi-Cal's annual cost to the federal government.
There are two problems with such solutions. First, they infringe on economic freedom, preventing, in Robert Nozick's phrase, "capitalist acts between consenting adults." Second, government solutions rarely work.
Why doesn't increased government power tend to solve the problem of the uninsured? There are two main reasons. First, when government provides health insurance, many people who take advantage of it drop their own privately provided health insurance. In a 1996 article in the Quarterly Journal of Economics, Harvard economists David M. Cutler and Jonathan Gruber found a 50% "crowding-out effect." As the federal Medicaid program expanded, for every two people who gained insurance through Medicaid, one dropped private health insurance. Although this is a net addition of one, the costs to taxpayers are much higher than expected because now half of the newly covered, instead of paying their own way as they previously did, become wards of the state.
Second, of the 46 million or so people without health insurance at any given time, about 45% will have health insurance within four months. This is one of the main findings of a 2003 study by the Congressional Budget Office, "How Many People Lack Health Insurance and for How Long?" That shouldn't be surprising in a country where most private health insurance is employer-provided and most unemployment spells last 11 weeks or less. Solutions that involve government mandates on employers or employees will, therefore, miss connecting with about half of the people who are uninsured at a given point in time.
But what if the governor could solve some of the problem by making health insurance cheaper? He can -- not by regulating more, but by deregulating.
Let me explain. In the last few decades, state governments, the main regulators of health insurance in the individual and small-group markets, have mandated coverages for many kinds of health care. According to the Council for Affordable Health Insurance (CAHI), a pro-market association of insurance carriers, there were 1,843 state mandates in 2006. Among the most common, and most expensive, mandates are chiropractic care, treatment for alcoholism and drug abuse, and mental health benefits. California's government mandates coverage for all of the above, as well as for many other benefits, including, for example, infertility treatment -- a very expensive benefit.
Abolishing these mandates would allow people who don't want to be covered for these things to buy cheaper insurance, while still allowing those who want them to buy and pay for them. Would such an approach work? That's like asking whether, if the government currently required new cars to have CD players, eliminating that requirement would lower the price of a car. Of course it would work.
It is important, though, not to overstate its benefits. The gain to Californians from abolishing these mandates would not be huge. CAHI compiled data from America's Health Insurance plan and eHealthInsurance for the individual market and from the federal government for the small-group market and found that in 2003, although California had more mandated coverages than all but six other states, it had among the lowest insurance rates for individual health insurance policies ($1,885 versus a top rate of $6,048 for New Jersey.)
The reason, explains CAHI, is that in other ways California is much less regulatory than many other states. It does not, for example, require guaranteed issue on individual policies -- which drives up premiums by forcing insurance companies to supply policies to all comers, regardless of health status. Yet the governor's proposal would reverse this somewhat and prevent insurance companies from saying no because of age and health.
California should not, contra Gov. Schwarzenegger, do new regulatory harm; rather it should repeal existing regulations that cause harm -- so as to make health insurance even more affordable.
There is one other way to deregulate: The California government could allow any Californian to buy health insurance from any willing insurer in any state and be subject to the regulations of that state. That way, people could shop for the degree of paternalism they want. If they want insurance from a state that requires many coverages, they could do so and pay the high premiums that result. If they want bare-bones coverage, they could do so also. The result would surely be that some of the current uninsured would buy insurance. Were I in the market for individual insurance and given the choice, I would not bother paying for coverage for alcohol or drug abuse.
If a version of Gov. Schwarzenegger's plan passes, the only thing certain is that there will be more regulation, more government spending and more taxes. A better path would be to deregulate, and thus achieve some increase in the number of insured -- without new spending or taxes or regulation.
Mr. Henderson, a research fellow at Stanford's Hoover Institution, was the senior economist for health policy with President Reagan's Council of Economics Advisers (1982-84). He is co-author of "Making Great Decisions in Business and Life" (Chicago Park Press, 2006).
Tuesday, January 02, 2007
Health Care Reform
TOPIC: Universal Health Care Reform
"The only reason universal coverage seems hard to achieve here is the
spectacular inefficiency of the U.S. health care system."
Dear Friends and Colleagues:
I want to wish you a Happy and Health New Year to all of you!
Attached an interesting OpEd from today's New York Times emphasizing an issue that many politicians still avoid discussing: COMPREHENSIVE AND UNIVERSAL HEALTH CARE REFORM.
Many may disagree with the authors proposals, but just ask your self why:
* we spent more money per capita and GDP on health care and still cannot provide comprehensive coverage
* we still struggle to exchange information in order to coordinate health care delivery
* we deprive citizens of insurance solutions just because they have a preexisting condition
* in South Florida the number of uninsured residents approaches 29% of the population!!!
* we neglect the development of preventive health care
* we still have wide variation in quality and outcome of health care delivery
As doctors we have to be part of the solution and not part of the problem. We must pro-actively participate in the discussion for comprehensive health care reform and provide positive and realistic perspectives.
My personal New Years resolution is to promote the discussion regarding universal coverage and comprehensive health care reform and will post articles discussing this issue on my blog http;//floridadocs.blogspot.com.
I also invite any interested colleague to join me in the development of a book in which doctors provide different perspectives for health care reform.
Such a book can be self published and can serve as a platform for an ongoing reform initiative.
Contact me if you are interested.
Yours
Bernd
January 1, 2007
Op-Ed Columnist
A Healthy New Year
By PAUL KRUGMAN
The U.S. health care system is a scandal and a disgrace. But maybe, just maybe, 2007 will be the year we start the move toward universal coverage.
In 2005, almost 47 million Americans — including more than 8 million children — were uninsured, and many more had inadequate insurance.
Apologists for our system try to minimize the significance of these numbers. Many of the uninsured, asserted the 2004 Economic Report of the President, “remain uninsured as a matter of choice.”
And then you wake up. A scathing article in yesterday’s Los Angeles Times described how insurers refuse to cover anyone with even the slightest hint of a pre-existing condition. People have been denied insurance for reasons that range from childhood asthma to a “past bout of jock itch.”
Some say that we can’t afford universal health care, even though every year lack of insurance plunges millions of Americans into severe financial distress and sends thousands to an early grave. But every other advanced country somehow manages to provide all its citizens with essential care. The only reason universal coverage seems hard to achieve here is the spectacular inefficiency of the U.S. health care system.
Americans spend more on health care per person than anyone else — almost twice as much as the French, whose medical care is among the best in the world. Yet we have the highest infant mortality and close to the lowest life expectancy of any wealthy nation. How do we do it?
Part of the answer is that our fragmented system has much higher administrative costs than the straightforward government insurance systems prevalent in the rest of the advanced world. As Anna Bernasek pointed out in yesterday’s New York Times, besides the overhead of private insurance companies, “there’s an enormous amount of paperwork required of American doctors and hospitals that simply doesn’t exist in countries like Canada or Britain.”
In addition, insurers often refuse to pay for preventive care, even though such care saves a lot of money in the long run, because those long-run savings won’t necessarily redound to their benefit. And the fragmentation of the American system explains why we lag far behind other nations in the use of electronic medical records, which both reduce costs and save lives by preventing many medical errors.
The truth is that we can afford to cover the uninsured. What we can’t afford is to keep going without a universal health care system.
If it were up to me, we’d have a Medicare-like system for everyone, paid for by a dedicated tax that for most people would be less than they or their employers currently pay in insurance premiums. This would, at a stroke, cover the uninsured, greatly reduce administrative costs and make it much easier to work on preventive care.
Such a system would leave people with the right to choose their own doctors, and with other choices as well: Medicare currently lets people apply their benefits to H.M.O.’s run by private insurance companies, and there’s no reason why similar options shouldn’t be available in a system of Medicare for all. But everyone would be in the system, one way or another.
Can we get there from here? Health care reform is in the air. Democrats in Congress are talking about providing health insurance to all children. John Edwards began his presidential campaign with a call for universal health care.
And there’s real action at the state level. Inspired by the Massachusetts plan to cover all its uninsured residents, politicians in other states are talking about adopting similar plans. Senator Ron Wyden of Oregon has introduced a Massachusetts-type plan for the nation as a whole.
But now is the time to warn against plans that try to cover the uninsured without taking on the fundamental sources of our health system’s inefficiency. What’s wrong with both the Massachusetts plan and Senator Wyden’s plan is that they don’t operate like Medicare; instead, they funnel the money through private insurance companies.
Everyone knows why: would-be reformers are trying to avoid too strong a backlash from the insurance industry and other players who profit from our current system’s irrationality.
But look at what happened to Bill Clinton. He rejected a single-payer approach, even though he understood its merits, in favor of a complex plan that was supposed to co-opt private insurance companies by giving them a largely gratuitous role. And the reward for this “pragmatism” was that insurance companies went all-out against his plan anyway, with the notorious “Harry and Louise” ads that, yes, mocked the plan’s complexity.
Now we have another chance for fundamental health care reform. Let’s not blow that chance with a pre-emptive surrender to the special interests.
"The only reason universal coverage seems hard to achieve here is the
spectacular inefficiency of the U.S. health care system."
Dear Friends and Colleagues:
I want to wish you a Happy and Health New Year to all of you!
Attached an interesting OpEd from today's New York Times emphasizing an issue that many politicians still avoid discussing: COMPREHENSIVE AND UNIVERSAL HEALTH CARE REFORM.
Many may disagree with the authors proposals, but just ask your self why:
* we spent more money per capita and GDP on health care and still cannot provide comprehensive coverage
* we still struggle to exchange information in order to coordinate health care delivery
* we deprive citizens of insurance solutions just because they have a preexisting condition
* in South Florida the number of uninsured residents approaches 29% of the population!!!
* we neglect the development of preventive health care
* we still have wide variation in quality and outcome of health care delivery
As doctors we have to be part of the solution and not part of the problem. We must pro-actively participate in the discussion for comprehensive health care reform and provide positive and realistic perspectives.
My personal New Years resolution is to promote the discussion regarding universal coverage and comprehensive health care reform and will post articles discussing this issue on my blog http;//floridadocs.blogspot.com.
I also invite any interested colleague to join me in the development of a book in which doctors provide different perspectives for health care reform.
Such a book can be self published and can serve as a platform for an ongoing reform initiative.
Contact me if you are interested.
Yours
Bernd
January 1, 2007
Op-Ed Columnist
A Healthy New Year
By PAUL KRUGMAN
The U.S. health care system is a scandal and a disgrace. But maybe, just maybe, 2007 will be the year we start the move toward universal coverage.
In 2005, almost 47 million Americans — including more than 8 million children — were uninsured, and many more had inadequate insurance.
Apologists for our system try to minimize the significance of these numbers. Many of the uninsured, asserted the 2004 Economic Report of the President, “remain uninsured as a matter of choice.”
And then you wake up. A scathing article in yesterday’s Los Angeles Times described how insurers refuse to cover anyone with even the slightest hint of a pre-existing condition. People have been denied insurance for reasons that range from childhood asthma to a “past bout of jock itch.”
Some say that we can’t afford universal health care, even though every year lack of insurance plunges millions of Americans into severe financial distress and sends thousands to an early grave. But every other advanced country somehow manages to provide all its citizens with essential care. The only reason universal coverage seems hard to achieve here is the spectacular inefficiency of the U.S. health care system.
Americans spend more on health care per person than anyone else — almost twice as much as the French, whose medical care is among the best in the world. Yet we have the highest infant mortality and close to the lowest life expectancy of any wealthy nation. How do we do it?
Part of the answer is that our fragmented system has much higher administrative costs than the straightforward government insurance systems prevalent in the rest of the advanced world. As Anna Bernasek pointed out in yesterday’s New York Times, besides the overhead of private insurance companies, “there’s an enormous amount of paperwork required of American doctors and hospitals that simply doesn’t exist in countries like Canada or Britain.”
In addition, insurers often refuse to pay for preventive care, even though such care saves a lot of money in the long run, because those long-run savings won’t necessarily redound to their benefit. And the fragmentation of the American system explains why we lag far behind other nations in the use of electronic medical records, which both reduce costs and save lives by preventing many medical errors.
The truth is that we can afford to cover the uninsured. What we can’t afford is to keep going without a universal health care system.
If it were up to me, we’d have a Medicare-like system for everyone, paid for by a dedicated tax that for most people would be less than they or their employers currently pay in insurance premiums. This would, at a stroke, cover the uninsured, greatly reduce administrative costs and make it much easier to work on preventive care.
Such a system would leave people with the right to choose their own doctors, and with other choices as well: Medicare currently lets people apply their benefits to H.M.O.’s run by private insurance companies, and there’s no reason why similar options shouldn’t be available in a system of Medicare for all. But everyone would be in the system, one way or another.
Can we get there from here? Health care reform is in the air. Democrats in Congress are talking about providing health insurance to all children. John Edwards began his presidential campaign with a call for universal health care.
And there’s real action at the state level. Inspired by the Massachusetts plan to cover all its uninsured residents, politicians in other states are talking about adopting similar plans. Senator Ron Wyden of Oregon has introduced a Massachusetts-type plan for the nation as a whole.
But now is the time to warn against plans that try to cover the uninsured without taking on the fundamental sources of our health system’s inefficiency. What’s wrong with both the Massachusetts plan and Senator Wyden’s plan is that they don’t operate like Medicare; instead, they funnel the money through private insurance companies.
Everyone knows why: would-be reformers are trying to avoid too strong a backlash from the insurance industry and other players who profit from our current system’s irrationality.
But look at what happened to Bill Clinton. He rejected a single-payer approach, even though he understood its merits, in favor of a complex plan that was supposed to co-opt private insurance companies by giving them a largely gratuitous role. And the reward for this “pragmatism” was that insurance companies went all-out against his plan anyway, with the notorious “Harry and Louise” ads that, yes, mocked the plan’s complexity.
Now we have another chance for fundamental health care reform. Let’s not blow that chance with a pre-emptive surrender to the special interests.
Sunday, December 17, 2006
Earmarks and P4P
"Medicare now pays the same amount regardless of quality .... even rewards poor quality,paying doctors to treat complications caused by their own mistakes."
Senators Charles E. Grassley, Republican of Iowa, the outgoing chairman of the Senate Finance Committee
“I am very skeptical of pay-for-performance. I’m not sure we can measure quality and performance that well."
Representative Henry A. Waxman, Democrat from California
Dear Friends and Colleagues:
Attached two recent articles from the New York Times highlighting two important issues: 1) last minute insertion of earmarks or special provisions into bills that favor pet projects for certain constituencies , 2) Pay-For-Quality measures in Medicare bill.
1) Earmarks or special provisions are increasing in an exponential fashion.Whereas Congress spent $10 billion on 1,439 such projects in 1995, it ran ran up $27.3 billion for a record 13,997 such projects last year, according to the nonpartisan Citizens Against Government Waste.
That means that our tax money is being used to satisfy the insatiable appetite of congress to funnel money away from budgeted projects to please local constituents. Medicares budget serves just as one example how precious resources are being squandered by politicians.Unfortunately, payment to doctors are being cut year by ear, if one takes inflation and increased practice expenditures into consideration. What can we do? Ally with our patients to point out those abuse by politicians and their financial backers and target them in the media. Lets not forget that doctors are also have their lobby in Washington, but we need to align our interests with the public to promote public health and not only our financial well being.
2) After averting a major pay cut, doctors have to prepare themselves for the next challenge: Pay-for-Quality. Now, doctors can qualify for a 1.5 percent bonus in the second half of 2007 if they report data on the quality of their care, using measures specified by the government. For example, doctors could be asked to report how often they prescribe a particular drug after a heart attack or how well they control blood pressure in patients with diabetes.Beyond broader questions about whether the government can accurately measure the quality of care, many are concerned about the feasibility of developing standards for hundreds of thousands of doctors within six months. The quality reporting system begins on July 1.
In a recent speech to the American Medical Association, Dr. Scott Gottlieb, deputy commissioner of the Food and Drug Administration, said he worried about intrusions into the practice of medicine by federal agencies, including his own.
We have several choices left: boycott Medicare and opt-out of the system or insist that we ONLY participate in such quality assessment program if they criteria are being developed with our significant input.
In my opinion, we cannot objectively measure quality in the ambulatory setting, unless we have tools i.e. medical information technology available and successfully implemented in the clinical practice. Then we should start with pilot projects to validate the feasibility of those assessments including outcome measures.
At this moment I think our elected politicians FROM BOTH PARTIES are shoveling those P4P measures down our throat.
My tip: don't swallow.
=======================================================================================
December 15, 2006
Last-Minute Inserts Offer Benefits in Medicare Bill
By ROBERT PEAR
WASHINGTON, Dec. 14 — By slipping four sentences into a big bill passed last week, Speaker J. Dennis Hastert secured a major change in Medicare policy avidly sought by a few health insurers, in particular a multinational company with headquarters in his home state, Illinois.
In the final hours of the 109th Congress, the Senate Democratic leader, Harry Reid of Nevada, also got special treatment for a hospice in his state. The bill did not name the hospice, but specified the Medicare provider number for the intended beneficiary, the Nathan Adelson Hospice in rural Pahrump, Nev.
Representative Bill Thomas, Republican of California, inserted a provision earmarking $40 million for a valley fever vaccine sought by his constituents, while the Senate Republican leader, Bill Frist of Tennessee, obtained tens of millions of dollars for hospitals in his state.
These examples illustrate how power is exercised in the final, chaotic hours before Congress adjourns. Obscure provisions of interest to just a few lawmakers were quietly stuffed into a grab bag of legislation, with no indication of their parentage or purpose.
The White House has indicated that President Bush will sign the bill, which deals not only with health care but also with a variety of tax and trade issues. The bill, for example, creates a special tax depreciation allowance for property used to produce ethanol from corn stalks, regulates the use of wine names like Champagne and Chablis, and suspends the tariff on imported rayon fibers used in making certain tampons.
Mr. Hastert’s provision showed up mysteriously after House and Senate negotiators had finished writing the bill. The provision was added by the House Rules Committee, just a few hours before the bill went to the House floor last week.
Congressional aides, Medicare officials and insurance lobbyists said the main proponent of the measure was the Aon Corporation and its subsidiary, Sterling Life Insurance Company. Aon, a Fortune 500 company, is based in Chicago and does business in more than 120 countries.
Under current law, Medicare beneficiaries can sign up for a prescription drug plan or a private Medicare Advantage plan from Nov. 15 to Dec. 31 each year. They have a limited ability to make changes through March 31 and are generally locked in for the remainder of the year.
Mr. Hastert’s amendment permits certain Medicare Advantage plans, like Aon’s, to enroll people throughout the year. Ron Bonjean, a spokesman for Mr. Hastert, said the purpose was “to get more people enrolled in Medicare Advantage plans.” Al Orendorff, a spokesman for Aon, said, “We are not going to comment.”
The provision could benefit several other insurers, but Larry Oday, a lawyer and lobbyist for Aon, said the company was “actively involved in consideration of this piece of legislation” and had led opposition to the lock-in requirement.
The addition of the provision infuriated Senate negotiators from both parties.
Senator Charles E. Grassley, the Iowa Republican who is chairman of the Senate Finance Committee, said the provision did not go through the regular legislative process.
“It disturbs me that this major policy change — one that treats some plans unfairly — was included at the last minute by the House Rules Committee,” Mr. Grassley said.
The senior Democrat on the Finance Committee, Senator Max Baucus of Montana, said: “I soundly rejected this proposal during negotiations with our House colleagues. They were clearly informed of my position. Our final agreement did not include this provision.”
Mr. Reid’s amendment provided $3.8 million in relief to the Nathan Adelson Hospice. Medicare officials said they had overpaid the hospice and were trying to recover that amount.
Mr. Reid said the legislation would overturn “a flawed administrative ruling” by the federal Centers for Medicare and Medicaid Services. The legislation retroactively designates the Adelson hospice in Pahrump as a branch of one in Las Vegas, making more money available.
Hospice trustees used their influence with the state’s Congressional delegation, and the hospice retained a Washington law firm, Hogan & Hartson. But Carole A. Fisher, president of the hospice, said Mr. Reid and Nevada’s Republican senator, John Ensign, “were the real champions of our cause, who ensured that we got relief from our Medicare debt.”
In Tennessee, hospitals estimate that they will get at least $131 million because of the provision added by Mr. Frist, who is retiring from the Senate next month. The money will go to about 90 hospitals serving disproportionate numbers of low-income Medicaid patients and people without insurance.
Craig A. Becker, president of the Tennessee Hospital Association, said his organization had received help from an influential Washington lobbyist: Thomas A. Scully, former administrator of the Centers for Medicare and Medicaid Services, who is now a lawyer at Alston & Bird.
The same section of the bill provides $10 million for hospitals in Hawaii. That state’s senators, Daniel K. Akaka and Daniel K. Inouye, both Democrats, have been trying to get such an allotment for years.
Hawaii, like Tennessee, is exempted from many requirements of the federal Medicaid law because of a waiver granted by federal officials. The waivers give the states a great deal of freedom in setting eligibility and benefits, but do not provide the extra money available to other states for hospitals serving large numbers of poor people.
In seeking money for a vaccine against valley fever, Mr. Thomas said he was addressing a serious health problem caused by inhalation of a soil-borne fungus in southwestern states.
“The disease is especially prevalent in Kern County, Calif., which I represent,” Mr. Thomas said. “Unfortunately, there is no vaccine for valley fever, and there is no private industry interest in making the investment, estimated at $40 million, needed for development of the vaccine.”
Among those seeking the legislation was Sandra P. Larson, executive director of the Valley Fever Americas Foundation in Bakersfield, Calif. “Thomas is the guy who got this done for us,” Ms. Larson said. “We are so appreciative.”
========================================================================================
December 12, 2006
Medicare Links Doctors’ Pay to Practices
By ROBERT PEAR
WASHINGTON, Dec. 11 — After years of trying to rein in the runaway cost of the Medicare program, Congress has decided to use a carrot instead of a stick to change doctors’ behavior.
Doctors had been fearing a pay cut under Medicare, the health care program for 43 million elderly and disabled, but Congress instead has offered doctors a small bonus with big strings attached. To get the money, doctors will have to report how often they provide quality care, as defined by the government.
Lawmakers approved the change as one of their final acts before adjourning early Saturday morning, and proponents said it would improve the quality of medical care.
But the plan immediately raised concerns among some doctors and lawmakers who specialize in health issues. They said they worried that it could be a step toward cookbook medicine and could erode the professional autonomy of doctors.
Doctors had been facing a 5 percent cut in Medicare payments in 2007. Congress deferred the cut, freezing doctors’ payment rates instead.
Now, doctors can qualify for a 1.5 percent bonus in the second half of 2007 if they report data on the quality of their care, using measures specified by the government. For example, doctors could be asked to report how often they prescribe a particular drug after a heart attack or how well they control blood pressure in patients with diabetes.
With these statistics, Medicare officials say, they will , in the near future, be able to reward doctors who follow clinical guidelines and perhaps penalize those who flout such standards without justification.
For several years, Medicare officials have advocated a pay-for-performance system, noting wide regional variations in the practices of hospitals and medical specialists. The idea was supported by the Bush administration and by Senators Charles E. Grassley, Republican of Iowa, the chairman of the Finance Committee, and Max Baucus, the Montana Democrat who will be chairman next year.
“Medicare now pays the same amount regardless of quality,” Mr. Grassley said. Indeed, he said, Medicare “rewards poor quality,” paying doctors to treat complications caused by their own mistakes.
But some influential Democrats, and even some administration officials and Republicans who support the general idea of pay-for-performance, expressed concern with federal agencies setting benchmarks for care.
“This is a very significant step,” Catherine G. Cohen, vice president of the American Academy of Ophthalmology, said Monday. “It’s the first time Medicare has ever paid individual doctors a differential for reporting quality measures. It could impose a significant new burden on doctors’ offices.”
The legislation has created strange bedfellows.
Some doctors, health policy experts and politicians, including liberals like Representative Henry A. Waxman and conservatives like Robert E. Moffit, director of health policy studies at the Heritage Foundation, are apprehensive. Beyond broader questions about whether the government can accurately measure the quality of care, they are concerned about the feasibility of developing standards for hundreds of thousands of doctors within six months. The quality reporting system begins on July 1.
In an interview, Mr. Waxman, a California Democrat who has been working on health policy for more than three decades, said: “I am very skeptical of pay-for-performance. I’m not sure we can measure quality and performance that well.”
Representative Pete Stark of California, who will become chairman of the Ways and Means Subcommittee on Health in January, said, “The entire concept of pay-for-performance is offensive.” Doctors, Mr. Stark said, are supposed to provide “quality care” and should not be paid extra for doing so.
Moreover, he said, federal officials “do not have the capability, the understanding, the knowledge or the training” to set standards for the quality of care.
Representative Charlie Norwood, Republican of Georgia, led efforts to enact a “patients’ bill of rights,” saying insurance companies should not tell doctors how to practice medicine. He objects just as much to government efforts to define quality.
“When government bureaucrats determine what good medicine is, instead of patients and doctors, I get very suspicious,” said Mr. Norwood, a dentist.
The administration says Medicare should not simply pay for more services, but should reward doctors for efficiency and high-quality care.
Representative Nancy L. Johnson, Republican of Connecticut, also championed the idea of pay-for-performance. But in an interview, Mrs. Johnson said she was disappointed that Congress had not gone further to ensure that doctors would develop the criteria for measuring quality. “Bureaucrats must never be allowed to dictate medical practice,” she said.
This concern is shared by some administration officials. In a recent speech to the American Medical Association, Dr. Scott Gottlieb, deputy commissioner of the Food and Drug Administration, said he worried about intrusions into the practice of medicine by federal agencies, including his own.
The original Medicare law, passed in 1965, said, “Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine.”
Mr. Moffit of the Heritage Foundation said the new initiative was “a backdoor attempt to repeal” this guarantee.
“It’s pay for compliance, not pay for performance,” Mr. Moffit said. “Doctors will be financially pressured to comply with government guidelines and standards. The integrity and independence of the medical profession could be compromised.”
Dr. Stephen C. Albrecht, a family doctor in Olympia, Wash., said Monday: “Medicare has a good idea here, but has not put much money behind it. The 1.5 percent bonus does not justify the extra effort required to do the quality reporting that the government wants.”
Some doctors, like anesthesiologists and thoracic surgeons, have been eager to develop their own quality measures.
Over the last 17 years, the Society of Thoracic Surgeons has collected demographic and clinical data on three million patients. Doctors say they have used the data to improve the quality of care.
Dr. Frederick L. Grover, president of the Society of Thoracic Surgeons, said, “We have provided feedback to doctors, comparing their performance with state and national benchmarks, and in this way we have significantly reduced mortality and complications.”
When possible, Medicare officials are supposed to use “quality measures” that have been endorsed by the private sector.
Despite the move toward pay-for-performance, Medicare payments to doctors are unlikely to keep pace with inflation. Congress postponed for one year a cut in fees but did not change the Medicare law’s formula for computing payments to doctors. They face an even bigger cut next year, in the range of 5 percent to 10 percent, ensuring that Congress will have to revisit the issue.
Representative Stark said, “Doctors and others who like pay-for-performance have to remember that it’s a zero-sum game.” As a result, he said, most doctors will have to accept lower fees if Medicare is to pay bonuses to the best performers.
Dr. Frank G. Opelka, a surgeon at the Louisiana State University School of Medicine in New Orleans, said: “We fully support the goal of enhancing the quality of care, but this is a new program. It will take some time to get broad acceptance by physicia
Senators Charles E. Grassley, Republican of Iowa, the outgoing chairman of the Senate Finance Committee
“I am very skeptical of pay-for-performance. I’m not sure we can measure quality and performance that well."
Representative Henry A. Waxman, Democrat from California
Dear Friends and Colleagues:
Attached two recent articles from the New York Times highlighting two important issues: 1) last minute insertion of earmarks or special provisions into bills that favor pet projects for certain constituencies , 2) Pay-For-Quality measures in Medicare bill.
1) Earmarks or special provisions are increasing in an exponential fashion.Whereas Congress spent $10 billion on 1,439 such projects in 1995, it ran ran up $27.3 billion for a record 13,997 such projects last year, according to the nonpartisan Citizens Against Government Waste.
That means that our tax money is being used to satisfy the insatiable appetite of congress to funnel money away from budgeted projects to please local constituents. Medicares budget serves just as one example how precious resources are being squandered by politicians.Unfortunately, payment to doctors are being cut year by ear, if one takes inflation and increased practice expenditures into consideration. What can we do? Ally with our patients to point out those abuse by politicians and their financial backers and target them in the media. Lets not forget that doctors are also have their lobby in Washington, but we need to align our interests with the public to promote public health and not only our financial well being.
2) After averting a major pay cut, doctors have to prepare themselves for the next challenge: Pay-for-Quality. Now, doctors can qualify for a 1.5 percent bonus in the second half of 2007 if they report data on the quality of their care, using measures specified by the government. For example, doctors could be asked to report how often they prescribe a particular drug after a heart attack or how well they control blood pressure in patients with diabetes.Beyond broader questions about whether the government can accurately measure the quality of care, many are concerned about the feasibility of developing standards for hundreds of thousands of doctors within six months. The quality reporting system begins on July 1.
In a recent speech to the American Medical Association, Dr. Scott Gottlieb, deputy commissioner of the Food and Drug Administration, said he worried about intrusions into the practice of medicine by federal agencies, including his own.
We have several choices left: boycott Medicare and opt-out of the system or insist that we ONLY participate in such quality assessment program if they criteria are being developed with our significant input.
In my opinion, we cannot objectively measure quality in the ambulatory setting, unless we have tools i.e. medical information technology available and successfully implemented in the clinical practice. Then we should start with pilot projects to validate the feasibility of those assessments including outcome measures.
At this moment I think our elected politicians FROM BOTH PARTIES are shoveling those P4P measures down our throat.
My tip: don't swallow.
=======================================================================================
December 15, 2006
Last-Minute Inserts Offer Benefits in Medicare Bill
By ROBERT PEAR
WASHINGTON, Dec. 14 — By slipping four sentences into a big bill passed last week, Speaker J. Dennis Hastert secured a major change in Medicare policy avidly sought by a few health insurers, in particular a multinational company with headquarters in his home state, Illinois.
In the final hours of the 109th Congress, the Senate Democratic leader, Harry Reid of Nevada, also got special treatment for a hospice in his state. The bill did not name the hospice, but specified the Medicare provider number for the intended beneficiary, the Nathan Adelson Hospice in rural Pahrump, Nev.
Representative Bill Thomas, Republican of California, inserted a provision earmarking $40 million for a valley fever vaccine sought by his constituents, while the Senate Republican leader, Bill Frist of Tennessee, obtained tens of millions of dollars for hospitals in his state.
These examples illustrate how power is exercised in the final, chaotic hours before Congress adjourns. Obscure provisions of interest to just a few lawmakers were quietly stuffed into a grab bag of legislation, with no indication of their parentage or purpose.
The White House has indicated that President Bush will sign the bill, which deals not only with health care but also with a variety of tax and trade issues. The bill, for example, creates a special tax depreciation allowance for property used to produce ethanol from corn stalks, regulates the use of wine names like Champagne and Chablis, and suspends the tariff on imported rayon fibers used in making certain tampons.
Mr. Hastert’s provision showed up mysteriously after House and Senate negotiators had finished writing the bill. The provision was added by the House Rules Committee, just a few hours before the bill went to the House floor last week.
Congressional aides, Medicare officials and insurance lobbyists said the main proponent of the measure was the Aon Corporation and its subsidiary, Sterling Life Insurance Company. Aon, a Fortune 500 company, is based in Chicago and does business in more than 120 countries.
Under current law, Medicare beneficiaries can sign up for a prescription drug plan or a private Medicare Advantage plan from Nov. 15 to Dec. 31 each year. They have a limited ability to make changes through March 31 and are generally locked in for the remainder of the year.
Mr. Hastert’s amendment permits certain Medicare Advantage plans, like Aon’s, to enroll people throughout the year. Ron Bonjean, a spokesman for Mr. Hastert, said the purpose was “to get more people enrolled in Medicare Advantage plans.” Al Orendorff, a spokesman for Aon, said, “We are not going to comment.”
The provision could benefit several other insurers, but Larry Oday, a lawyer and lobbyist for Aon, said the company was “actively involved in consideration of this piece of legislation” and had led opposition to the lock-in requirement.
The addition of the provision infuriated Senate negotiators from both parties.
Senator Charles E. Grassley, the Iowa Republican who is chairman of the Senate Finance Committee, said the provision did not go through the regular legislative process.
“It disturbs me that this major policy change — one that treats some plans unfairly — was included at the last minute by the House Rules Committee,” Mr. Grassley said.
The senior Democrat on the Finance Committee, Senator Max Baucus of Montana, said: “I soundly rejected this proposal during negotiations with our House colleagues. They were clearly informed of my position. Our final agreement did not include this provision.”
Mr. Reid’s amendment provided $3.8 million in relief to the Nathan Adelson Hospice. Medicare officials said they had overpaid the hospice and were trying to recover that amount.
Mr. Reid said the legislation would overturn “a flawed administrative ruling” by the federal Centers for Medicare and Medicaid Services. The legislation retroactively designates the Adelson hospice in Pahrump as a branch of one in Las Vegas, making more money available.
Hospice trustees used their influence with the state’s Congressional delegation, and the hospice retained a Washington law firm, Hogan & Hartson. But Carole A. Fisher, president of the hospice, said Mr. Reid and Nevada’s Republican senator, John Ensign, “were the real champions of our cause, who ensured that we got relief from our Medicare debt.”
In Tennessee, hospitals estimate that they will get at least $131 million because of the provision added by Mr. Frist, who is retiring from the Senate next month. The money will go to about 90 hospitals serving disproportionate numbers of low-income Medicaid patients and people without insurance.
Craig A. Becker, president of the Tennessee Hospital Association, said his organization had received help from an influential Washington lobbyist: Thomas A. Scully, former administrator of the Centers for Medicare and Medicaid Services, who is now a lawyer at Alston & Bird.
The same section of the bill provides $10 million for hospitals in Hawaii. That state’s senators, Daniel K. Akaka and Daniel K. Inouye, both Democrats, have been trying to get such an allotment for years.
Hawaii, like Tennessee, is exempted from many requirements of the federal Medicaid law because of a waiver granted by federal officials. The waivers give the states a great deal of freedom in setting eligibility and benefits, but do not provide the extra money available to other states for hospitals serving large numbers of poor people.
In seeking money for a vaccine against valley fever, Mr. Thomas said he was addressing a serious health problem caused by inhalation of a soil-borne fungus in southwestern states.
“The disease is especially prevalent in Kern County, Calif., which I represent,” Mr. Thomas said. “Unfortunately, there is no vaccine for valley fever, and there is no private industry interest in making the investment, estimated at $40 million, needed for development of the vaccine.”
Among those seeking the legislation was Sandra P. Larson, executive director of the Valley Fever Americas Foundation in Bakersfield, Calif. “Thomas is the guy who got this done for us,” Ms. Larson said. “We are so appreciative.”
========================================================================================
December 12, 2006
Medicare Links Doctors’ Pay to Practices
By ROBERT PEAR
WASHINGTON, Dec. 11 — After years of trying to rein in the runaway cost of the Medicare program, Congress has decided to use a carrot instead of a stick to change doctors’ behavior.
Doctors had been fearing a pay cut under Medicare, the health care program for 43 million elderly and disabled, but Congress instead has offered doctors a small bonus with big strings attached. To get the money, doctors will have to report how often they provide quality care, as defined by the government.
Lawmakers approved the change as one of their final acts before adjourning early Saturday morning, and proponents said it would improve the quality of medical care.
But the plan immediately raised concerns among some doctors and lawmakers who specialize in health issues. They said they worried that it could be a step toward cookbook medicine and could erode the professional autonomy of doctors.
Doctors had been facing a 5 percent cut in Medicare payments in 2007. Congress deferred the cut, freezing doctors’ payment rates instead.
Now, doctors can qualify for a 1.5 percent bonus in the second half of 2007 if they report data on the quality of their care, using measures specified by the government. For example, doctors could be asked to report how often they prescribe a particular drug after a heart attack or how well they control blood pressure in patients with diabetes.
With these statistics, Medicare officials say, they will , in the near future, be able to reward doctors who follow clinical guidelines and perhaps penalize those who flout such standards without justification.
For several years, Medicare officials have advocated a pay-for-performance system, noting wide regional variations in the practices of hospitals and medical specialists. The idea was supported by the Bush administration and by Senators Charles E. Grassley, Republican of Iowa, the chairman of the Finance Committee, and Max Baucus, the Montana Democrat who will be chairman next year.
“Medicare now pays the same amount regardless of quality,” Mr. Grassley said. Indeed, he said, Medicare “rewards poor quality,” paying doctors to treat complications caused by their own mistakes.
But some influential Democrats, and even some administration officials and Republicans who support the general idea of pay-for-performance, expressed concern with federal agencies setting benchmarks for care.
“This is a very significant step,” Catherine G. Cohen, vice president of the American Academy of Ophthalmology, said Monday. “It’s the first time Medicare has ever paid individual doctors a differential for reporting quality measures. It could impose a significant new burden on doctors’ offices.”
The legislation has created strange bedfellows.
Some doctors, health policy experts and politicians, including liberals like Representative Henry A. Waxman and conservatives like Robert E. Moffit, director of health policy studies at the Heritage Foundation, are apprehensive. Beyond broader questions about whether the government can accurately measure the quality of care, they are concerned about the feasibility of developing standards for hundreds of thousands of doctors within six months. The quality reporting system begins on July 1.
In an interview, Mr. Waxman, a California Democrat who has been working on health policy for more than three decades, said: “I am very skeptical of pay-for-performance. I’m not sure we can measure quality and performance that well.”
Representative Pete Stark of California, who will become chairman of the Ways and Means Subcommittee on Health in January, said, “The entire concept of pay-for-performance is offensive.” Doctors, Mr. Stark said, are supposed to provide “quality care” and should not be paid extra for doing so.
Moreover, he said, federal officials “do not have the capability, the understanding, the knowledge or the training” to set standards for the quality of care.
Representative Charlie Norwood, Republican of Georgia, led efforts to enact a “patients’ bill of rights,” saying insurance companies should not tell doctors how to practice medicine. He objects just as much to government efforts to define quality.
“When government bureaucrats determine what good medicine is, instead of patients and doctors, I get very suspicious,” said Mr. Norwood, a dentist.
The administration says Medicare should not simply pay for more services, but should reward doctors for efficiency and high-quality care.
Representative Nancy L. Johnson, Republican of Connecticut, also championed the idea of pay-for-performance. But in an interview, Mrs. Johnson said she was disappointed that Congress had not gone further to ensure that doctors would develop the criteria for measuring quality. “Bureaucrats must never be allowed to dictate medical practice,” she said.
This concern is shared by some administration officials. In a recent speech to the American Medical Association, Dr. Scott Gottlieb, deputy commissioner of the Food and Drug Administration, said he worried about intrusions into the practice of medicine by federal agencies, including his own.
The original Medicare law, passed in 1965, said, “Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine.”
Mr. Moffit of the Heritage Foundation said the new initiative was “a backdoor attempt to repeal” this guarantee.
“It’s pay for compliance, not pay for performance,” Mr. Moffit said. “Doctors will be financially pressured to comply with government guidelines and standards. The integrity and independence of the medical profession could be compromised.”
Dr. Stephen C. Albrecht, a family doctor in Olympia, Wash., said Monday: “Medicare has a good idea here, but has not put much money behind it. The 1.5 percent bonus does not justify the extra effort required to do the quality reporting that the government wants.”
Some doctors, like anesthesiologists and thoracic surgeons, have been eager to develop their own quality measures.
Over the last 17 years, the Society of Thoracic Surgeons has collected demographic and clinical data on three million patients. Doctors say they have used the data to improve the quality of care.
Dr. Frederick L. Grover, president of the Society of Thoracic Surgeons, said, “We have provided feedback to doctors, comparing their performance with state and national benchmarks, and in this way we have significantly reduced mortality and complications.”
When possible, Medicare officials are supposed to use “quality measures” that have been endorsed by the private sector.
Despite the move toward pay-for-performance, Medicare payments to doctors are unlikely to keep pace with inflation. Congress postponed for one year a cut in fees but did not change the Medicare law’s formula for computing payments to doctors. They face an even bigger cut next year, in the range of 5 percent to 10 percent, ensuring that Congress will have to revisit the issue.
Representative Stark said, “Doctors and others who like pay-for-performance have to remember that it’s a zero-sum game.” As a result, he said, most doctors will have to accept lower fees if Medicare is to pay bonuses to the best performers.
Dr. Frank G. Opelka, a surgeon at the Louisiana State University School of Medicine in New Orleans, said: “We fully support the goal of enhancing the quality of care, but this is a new program. It will take some time to get broad acceptance by physicia
Helath Care Costs and Quality of Care
TOPIC: Healthcare Costs and Quality of Care
“The biggest failure of the American health care system is not that we overuse stuff but that we underuse stuff,”
(David Cutler, Economist,Harvard)
Dear Friends and Colleagues:
Attached two articles from the Miami herald and New York Times discussing the paradox of increasing health car costs and decreasing quality of care.
John Dorscher, the renowned Miami Herald health care reporter, reviews the costs, quality and outcome of medical care in South Florida.
Unfortunately, we have the highest per capita healthcare expenditures, but our performance is the lowest in the country.
In plain simple English: our patients (including your employees and families) or their insurance spent the most, but get the short end of the stick.
Among others the following factors contribute to this problem: fragmented health care system, uncoordinated health care delivery, poor or non-existing information sharing resulting in unnecessary duplication of diagnostic testing and absence of quality measures in ambulatory care setting.
Unfortunately, doctors are still resisting to conduct performance and outcome measure assessments.
These measures are not meant to be punitive, but to provide guidance for physicians to assess and compare their performance.
For that purpose I am using for more than seven years an electronic health records and routinely check if the treatment of my patients with certain chronic disease (Diabetes, Hypertension, Asthma) meets the standards of care and complies with national guidelines.
I learn a lot from those routine reviews and adjust my care accordingly.
If I can do it, why do we have to wait for the government to prescribe how we should practice medicine?
Lets take the initiative and implement modern business management principles in our practices including medical information technology.
Looking forward to your comments.
Happy Chanukah and Merry Christmas.
Yours
Bernd
Posted on Sun, Dec. 17, 2006
HEALTHCARE | FIFTH OF AN OCCASIONAL SERIES
High prices don't translate into better healthcare in South Florida
In the still murky world of healthcare information, high costs of healthcare are not at all linked to high quality care in South Florida.
BY JOHN DORSCHNER
jdorschner@MiamiHerald.com
With studies showing that South Florida has among the highest healthcare costs in the country, consumers might assume local hospitals' performance on quality standards would be among the tops in the country.
Think again.
After a thorough examination of quality data made public by Medicare, Harvard researchers have discovered South Florida's performance is among the worst in the country in two out of three key categories.
Their findings reveal what many experts now see as a growing amount of health information becomes available: The relationships among costs, the quality of treatment and ultimate outcome is murky at best. That means measuring proper treatments may not have much to do with costs at the moment -- or even whether the patient lives longer.
Insurers and the federal government want the consumers to have more health information to make better choices and to pay providers according to their performances. In theory, it's great. In reality, providers fear it it may be something else.
''Though I am supporting transparency in healthcare pricing and the patients (sic) right to receive high-quality care, I am concerned that insurers may just focus on cheaper and not necessarily better,'' wrote North Miami Beach doctor Bernd Wollschlaeger in a letter to colleagues after a recent Miami Herald report on healthcare pricing.
In fact, Wollschlaeger believes one problem may be that there is not enough information. One major example: South Florida doctors usually don't know whether the patient received the proper test at the hospital, meaning they frequently order the same test again.
Unnecessary repetition of services and tests, frequently caused by excessive trips to specialists, is one reason why researchers of the Dartmouth Medical School have found that per capita healthcare costs in Miami are almost twice what they are in Minneapolis, another similar-size city they studied.
Contrast that with the findings of four researchers from Harvard's School of Public Health who studied the 40 largest hospital markets in the United States for the basic Medicare quality measures, such as giving aspirin to a patient after a heart attack.
BOTTOM FIVE
In two of the three main categories -- treatment for heart attack and for pneumonia -- the Miami region ranked in the bottom five, the researchers wrote in their article, published in the New England Journal of Medicine. For the third category, congestive heart failure, it didn't do much better, finishing 29th out of 40.
''These are very simple but really important things to perform,'' says Ashish K. Jha, the lead Harvard researcher. ``Aspirins, beta-blockers -- things that can cost pennies but can be crucial.''
Meanwhile, Florida's healthcare dollars are being spent much more frequently, according to a Dartmouth study released in May. During the last six months of life, the average Medicare recipient spends twice as many days in intensive care and has twice as many doctor visits as his counterpart in Utah.
Within Florida, a patient in Miami spends twice as much time in intensive care and sees twice as many specialists in those last six months than does a patient in Fort Myers.
Alan Sager, a Boston University health professor, thinks these big-picture spending contrasts are what the industry should be looking at, not insurers revealing provider prices.
After The Miami Herald ran a report about insurers making public health cost and pricing information as a prelude to steering consumers toward more efficient providers, Sager sent an e-mail to The Miami Herald: ``Shopping by price won't save serious money because it addresses the wrong question. The big question is not, where's the cheapest place to get the operation, MRI or primary care visit? The big question is, do I need the operation, MRI or visit?''
UNNECESSARY EXPENSES
Sager, like many other experts, believes about half of all healthcare expenses are unnecessary, and if needless work could be curtailed, then America could provide healthcare for everyone.
The nonprofit National Committee for Quality Assurance, which has been measuring health plan performance on various measures for a decade, is now starting to look into these broader ''efficiency'' questions.
NCQA is starting a pilot that will go beyond measuring health plans' quality -- making sure diabetics get blood-sugar tests -- to look at cost, and not just for specific measures.
''We're going to focus on the total cost of healthcare,'' says NCQA Vice President Joachim Roski. ``It could mean you spend money in some areas, but not in others. You might spend more on preventive visits or more on pharmacy but spend less on hospitalizations.''
Adjusting for risk factors such as age and health condition, NCQA plans to release its first efficiency data in September 2007. ''The ultimate question is, do organizations in Miami get the same level of quality with the same level of cost?'' says Roski. ``And if not, why not?''
Brian Klepper, head of the Center for Practical Health Reform, agrees that many healthcare dollars are spent on unnecessary care. He thinks a primary cause may be the present fee-for-service model, in which the more doctors do, the more they get paid. He points out that some years ago, when the state lowered provider payments for workers' compensation treatment, the doctors responded by finding more treatments to do on each patient.
Klepper thinks that payment model has to be changed -- so that doctors get sums for a total treatment of an illness, not for each incremental step -- but he also believes that there must be greater transparency in the system.
Klepper and Wollschlaeger, the doctor who is a delegate to the American Medical Association, believe one good way to provide transparency and cut unnecessary costs is to form regional health information systems.
That way, doctors can see online what other providers have already done for a patient, particularly important in South Florida, which has 40 percent more specialists than does Minneapolis -- a fact that Dartmouth researchers believe causes many duplicative services here.
With providers sharing patient information online, that means someone like Wollschlaeger can see that a patient just released from the hospital ''has already had the pneumonia vaccination shot, so I don't have to order another one for $85,'' says Wollschlaeger.
Discussions about forming a network in South Florida, however, are just getting under way. In the meantime, many are still struggling to comprehend the meaning of the data now available.
A study published Wednesday in the Journal of the American Medical Association found that performance measures reported by Medicare for 3,657 hospitals ''are not tightly linked to patient outcomes,'' meaning that hospitals that are doing a good job of giving, say, the beta-blocker at the right moment are not necessarily showing a good job in lowering mortality rates.
''These findings should not undermine current efforts to improve healthcare quality through measurement and reporting,'' wrote the researchers, headed by Rachel M. Werner. ``However, attention should be focused on finding measures of healthcare quality that are more tightly linked to patient outcomes. Only then will performance measurement live up to expectations for improving healthcare quality.''
================================================================================
December 17, 2006
Economic View
The More You Pay, the Better the Care? Think Twice
By EDUARDO PORTER
EXPERTS have long been puzzled by the existence of large regional disparities in medical care in the United States. Even for diseases for which the appropriate treatment is widely accepted, doctors across the country take vastly different approaches, often leading to enormous expense without making any appreciable improvement in their patients’ health.
Consider heart attacks. Prescribing beta blockers immediately after a heart attack is a well-established, cheap and efficient treatment. In Iowa, nearly 80 percent of victims in 2000 received the drugs within 24 hours of a heart attack. In Alabama or Georgia, by contrast, fewer than 6 out of 10 patients received the drugs.
“What makes the lag in beta-blocker adoption puzzling is that the clinical benefits have been understood for years,” wrote Jonathan S. Skinner and Douglas O. Staiger, economists at Dartmouth, in a recent study about these regional patterns.
Congress has decided that some treatment decisions may be best taken out of doctors’ hands. In one of their last acts this year before adjourning, lawmakers passed a bill entitling doctors to a bonus from Medicare if they report data on the quality of their care, using criteria like whether they prescribe aspirin or beta blockers to heart attack victims. In the future, this data would permit Medicare to reward doctors who followed government guidelines.
Many doctors criticized the decision, saying it would impose a form of medicine by cookbook that could endanger patients. Still, some experts contend that this form of accountability is a necessary step to deal with inefficiencies that riddle the health care system and fuel much unnecessary spending on care.
Several new studies suggest that there is no relationship between the amount spent on treating a patient and the quality and outcome of the care.
Consider chronically ill elderly patients in the last two years of their lives. According to a comparison of hospitals across the country done by researchers at Dartmouth, if the patients die in a hospital in New York State, the average cost of those two years would be $38,369. In Florida, by contrast, it would be $29,604, while in Iowa it would be only $23,746.
To be sure, much spending on health care provides enormous benefits. A study published this year by Mr. Skinner, Mr. Staiger and Dr. Elliott S. Fisher of Dartmouth Medical School found that Medicare spending on hospital care for heart attack victims surged two-thirds from 1986 to 1996, after accounting for inflation. But the percentage of victims who were alive a year after their attacks also increased, though by just 10 percentage points, to roughly 68 percent.
The relationship — rising costs bringing increased benefits — has broken down recently. From 1996 to 2002, Medicare spending on treatments for heart attack victims increased about 14 percent, after inflation. But there was virtually no improvement in survival rates.
There is mounting evidence that the zeal to treat and spend may actually hurt patients. The study by Mr. Skinner, Mr. Staiger and Dr. Fisher found that hospitals in regions where spending grew fastest from 1986 to 2002 had some of the worst practices, in terms of providing tried-and-true therapies, and recorded the smallest gains in survival rates.
Treatment of heart disease underscores the deeply idiosyncratic nature of many choices made by America’s doctors and hospitals. Coupled with a fee-for-service system that encourages aggressive treatment, these choices stimulate health spending that provides little benefit to patients. “A lot of the innovation and spending growth are going into gray areas that are not helping people that much,” Mr. Skinner said.
But perhaps the most puzzling inefficiency in how doctors treat heart disease is not the spending on fancy yet ineffective therapies. It’s the lack of spending on treatments that have been known to work for years, like beta blockers.
“The biggest failure of the American health care system is not that we overuse stuff but that we underuse stuff,” said David Cutler, an economist at Harvard. Consider aspirin. It helps prevent formation of blood clots, and its widespread use has probably been the cheapest breakthrough in the history of heart disease treatment.
A study five years ago by Dr. Mark McClellan, who was to become the commissioner of the Food and Drug Administration, and Dr. Paul A. Heidenreich of the Veterans Affairs Palo Alto Health Care System in California, estimated that growing aspirin use explained more than a third of the decrease in the death rates of heart attack victims from 1975 to 1995.
Still, a Duke University study of about 32,000 patients with coronary artery disease who were treated from 1995 to 2002 found that only 83 percent took aspirin. And only 71 percent did so consistently.
The financial incentives in the health care system are part of the problem, experts say. These incentives encourage hospitals and clinics to provide more services, hire more specialists and install more devices. They shuttle patients from one specialist to the other — providing more-scattered care. All too often, when the patient leaves the hospital, nobody among the crowd of doctors takes responsibility for prescribing the beta-blockers. “The system rewards throughput and higher-margin services,” Dr. Fisher said. “This leads us inadvertently to waste and inadvertently to harm.”
He argued that hospitals and doctors must gather into bigger units that coordinate care smoothly — sharing medical records and responsibility for a patient’s overall health. They should provide information about treatments and outcomes. And, he said, Medicare must start paying for results, measured in terms of lives improved and extended and of value for the money.
Congress has taken a step in this direction. But changing entrenched practices is not easy.
MR. SKINNER and Mr. Staiger found an odd pattern in the regional propensities of doctors to prescribe beta blockers: it closely matched the propensities of farmers to embrace hybrid corn early in the 20th century.
Hybridization spread through Iowa’s cornfields as early as the mid-1930s. By contrast, in Alabama and Georgia it didn’t take hold until the late 1940s. In other words, the lag in the prescription of beta blockers is not simply a problem of the health care system. It also reflects regional attitudes about the adoption of new technologies, the study concluded. That problem could take generations to solve.
“The biggest failure of the American health care system is not that we overuse stuff but that we underuse stuff,”
(David Cutler, Economist,Harvard)
Dear Friends and Colleagues:
Attached two articles from the Miami herald and New York Times discussing the paradox of increasing health car costs and decreasing quality of care.
John Dorscher, the renowned Miami Herald health care reporter, reviews the costs, quality and outcome of medical care in South Florida.
Unfortunately, we have the highest per capita healthcare expenditures, but our performance is the lowest in the country.
In plain simple English: our patients (including your employees and families) or their insurance spent the most, but get the short end of the stick.
Among others the following factors contribute to this problem: fragmented health care system, uncoordinated health care delivery, poor or non-existing information sharing resulting in unnecessary duplication of diagnostic testing and absence of quality measures in ambulatory care setting.
Unfortunately, doctors are still resisting to conduct performance and outcome measure assessments.
These measures are not meant to be punitive, but to provide guidance for physicians to assess and compare their performance.
For that purpose I am using for more than seven years an electronic health records and routinely check if the treatment of my patients with certain chronic disease (Diabetes, Hypertension, Asthma) meets the standards of care and complies with national guidelines.
I learn a lot from those routine reviews and adjust my care accordingly.
If I can do it, why do we have to wait for the government to prescribe how we should practice medicine?
Lets take the initiative and implement modern business management principles in our practices including medical information technology.
Looking forward to your comments.
Happy Chanukah and Merry Christmas.
Yours
Bernd
Posted on Sun, Dec. 17, 2006
HEALTHCARE | FIFTH OF AN OCCASIONAL SERIES
High prices don't translate into better healthcare in South Florida
In the still murky world of healthcare information, high costs of healthcare are not at all linked to high quality care in South Florida.
BY JOHN DORSCHNER
jdorschner@MiamiHerald.com
With studies showing that South Florida has among the highest healthcare costs in the country, consumers might assume local hospitals' performance on quality standards would be among the tops in the country.
Think again.
After a thorough examination of quality data made public by Medicare, Harvard researchers have discovered South Florida's performance is among the worst in the country in two out of three key categories.
Their findings reveal what many experts now see as a growing amount of health information becomes available: The relationships among costs, the quality of treatment and ultimate outcome is murky at best. That means measuring proper treatments may not have much to do with costs at the moment -- or even whether the patient lives longer.
Insurers and the federal government want the consumers to have more health information to make better choices and to pay providers according to their performances. In theory, it's great. In reality, providers fear it it may be something else.
''Though I am supporting transparency in healthcare pricing and the patients (sic) right to receive high-quality care, I am concerned that insurers may just focus on cheaper and not necessarily better,'' wrote North Miami Beach doctor Bernd Wollschlaeger in a letter to colleagues after a recent Miami Herald report on healthcare pricing.
In fact, Wollschlaeger believes one problem may be that there is not enough information. One major example: South Florida doctors usually don't know whether the patient received the proper test at the hospital, meaning they frequently order the same test again.
Unnecessary repetition of services and tests, frequently caused by excessive trips to specialists, is one reason why researchers of the Dartmouth Medical School have found that per capita healthcare costs in Miami are almost twice what they are in Minneapolis, another similar-size city they studied.
Contrast that with the findings of four researchers from Harvard's School of Public Health who studied the 40 largest hospital markets in the United States for the basic Medicare quality measures, such as giving aspirin to a patient after a heart attack.
BOTTOM FIVE
In two of the three main categories -- treatment for heart attack and for pneumonia -- the Miami region ranked in the bottom five, the researchers wrote in their article, published in the New England Journal of Medicine. For the third category, congestive heart failure, it didn't do much better, finishing 29th out of 40.
''These are very simple but really important things to perform,'' says Ashish K. Jha, the lead Harvard researcher. ``Aspirins, beta-blockers -- things that can cost pennies but can be crucial.''
Meanwhile, Florida's healthcare dollars are being spent much more frequently, according to a Dartmouth study released in May. During the last six months of life, the average Medicare recipient spends twice as many days in intensive care and has twice as many doctor visits as his counterpart in Utah.
Within Florida, a patient in Miami spends twice as much time in intensive care and sees twice as many specialists in those last six months than does a patient in Fort Myers.
Alan Sager, a Boston University health professor, thinks these big-picture spending contrasts are what the industry should be looking at, not insurers revealing provider prices.
After The Miami Herald ran a report about insurers making public health cost and pricing information as a prelude to steering consumers toward more efficient providers, Sager sent an e-mail to The Miami Herald: ``Shopping by price won't save serious money because it addresses the wrong question. The big question is not, where's the cheapest place to get the operation, MRI or primary care visit? The big question is, do I need the operation, MRI or visit?''
UNNECESSARY EXPENSES
Sager, like many other experts, believes about half of all healthcare expenses are unnecessary, and if needless work could be curtailed, then America could provide healthcare for everyone.
The nonprofit National Committee for Quality Assurance, which has been measuring health plan performance on various measures for a decade, is now starting to look into these broader ''efficiency'' questions.
NCQA is starting a pilot that will go beyond measuring health plans' quality -- making sure diabetics get blood-sugar tests -- to look at cost, and not just for specific measures.
''We're going to focus on the total cost of healthcare,'' says NCQA Vice President Joachim Roski. ``It could mean you spend money in some areas, but not in others. You might spend more on preventive visits or more on pharmacy but spend less on hospitalizations.''
Adjusting for risk factors such as age and health condition, NCQA plans to release its first efficiency data in September 2007. ''The ultimate question is, do organizations in Miami get the same level of quality with the same level of cost?'' says Roski. ``And if not, why not?''
Brian Klepper, head of the Center for Practical Health Reform, agrees that many healthcare dollars are spent on unnecessary care. He thinks a primary cause may be the present fee-for-service model, in which the more doctors do, the more they get paid. He points out that some years ago, when the state lowered provider payments for workers' compensation treatment, the doctors responded by finding more treatments to do on each patient.
Klepper thinks that payment model has to be changed -- so that doctors get sums for a total treatment of an illness, not for each incremental step -- but he also believes that there must be greater transparency in the system.
Klepper and Wollschlaeger, the doctor who is a delegate to the American Medical Association, believe one good way to provide transparency and cut unnecessary costs is to form regional health information systems.
That way, doctors can see online what other providers have already done for a patient, particularly important in South Florida, which has 40 percent more specialists than does Minneapolis -- a fact that Dartmouth researchers believe causes many duplicative services here.
With providers sharing patient information online, that means someone like Wollschlaeger can see that a patient just released from the hospital ''has already had the pneumonia vaccination shot, so I don't have to order another one for $85,'' says Wollschlaeger.
Discussions about forming a network in South Florida, however, are just getting under way. In the meantime, many are still struggling to comprehend the meaning of the data now available.
A study published Wednesday in the Journal of the American Medical Association found that performance measures reported by Medicare for 3,657 hospitals ''are not tightly linked to patient outcomes,'' meaning that hospitals that are doing a good job of giving, say, the beta-blocker at the right moment are not necessarily showing a good job in lowering mortality rates.
''These findings should not undermine current efforts to improve healthcare quality through measurement and reporting,'' wrote the researchers, headed by Rachel M. Werner. ``However, attention should be focused on finding measures of healthcare quality that are more tightly linked to patient outcomes. Only then will performance measurement live up to expectations for improving healthcare quality.''
================================================================================
December 17, 2006
Economic View
The More You Pay, the Better the Care? Think Twice
By EDUARDO PORTER
EXPERTS have long been puzzled by the existence of large regional disparities in medical care in the United States. Even for diseases for which the appropriate treatment is widely accepted, doctors across the country take vastly different approaches, often leading to enormous expense without making any appreciable improvement in their patients’ health.
Consider heart attacks. Prescribing beta blockers immediately after a heart attack is a well-established, cheap and efficient treatment. In Iowa, nearly 80 percent of victims in 2000 received the drugs within 24 hours of a heart attack. In Alabama or Georgia, by contrast, fewer than 6 out of 10 patients received the drugs.
“What makes the lag in beta-blocker adoption puzzling is that the clinical benefits have been understood for years,” wrote Jonathan S. Skinner and Douglas O. Staiger, economists at Dartmouth, in a recent study about these regional patterns.
Congress has decided that some treatment decisions may be best taken out of doctors’ hands. In one of their last acts this year before adjourning, lawmakers passed a bill entitling doctors to a bonus from Medicare if they report data on the quality of their care, using criteria like whether they prescribe aspirin or beta blockers to heart attack victims. In the future, this data would permit Medicare to reward doctors who followed government guidelines.
Many doctors criticized the decision, saying it would impose a form of medicine by cookbook that could endanger patients. Still, some experts contend that this form of accountability is a necessary step to deal with inefficiencies that riddle the health care system and fuel much unnecessary spending on care.
Several new studies suggest that there is no relationship between the amount spent on treating a patient and the quality and outcome of the care.
Consider chronically ill elderly patients in the last two years of their lives. According to a comparison of hospitals across the country done by researchers at Dartmouth, if the patients die in a hospital in New York State, the average cost of those two years would be $38,369. In Florida, by contrast, it would be $29,604, while in Iowa it would be only $23,746.
To be sure, much spending on health care provides enormous benefits. A study published this year by Mr. Skinner, Mr. Staiger and Dr. Elliott S. Fisher of Dartmouth Medical School found that Medicare spending on hospital care for heart attack victims surged two-thirds from 1986 to 1996, after accounting for inflation. But the percentage of victims who were alive a year after their attacks also increased, though by just 10 percentage points, to roughly 68 percent.
The relationship — rising costs bringing increased benefits — has broken down recently. From 1996 to 2002, Medicare spending on treatments for heart attack victims increased about 14 percent, after inflation. But there was virtually no improvement in survival rates.
There is mounting evidence that the zeal to treat and spend may actually hurt patients. The study by Mr. Skinner, Mr. Staiger and Dr. Fisher found that hospitals in regions where spending grew fastest from 1986 to 2002 had some of the worst practices, in terms of providing tried-and-true therapies, and recorded the smallest gains in survival rates.
Treatment of heart disease underscores the deeply idiosyncratic nature of many choices made by America’s doctors and hospitals. Coupled with a fee-for-service system that encourages aggressive treatment, these choices stimulate health spending that provides little benefit to patients. “A lot of the innovation and spending growth are going into gray areas that are not helping people that much,” Mr. Skinner said.
But perhaps the most puzzling inefficiency in how doctors treat heart disease is not the spending on fancy yet ineffective therapies. It’s the lack of spending on treatments that have been known to work for years, like beta blockers.
“The biggest failure of the American health care system is not that we overuse stuff but that we underuse stuff,” said David Cutler, an economist at Harvard. Consider aspirin. It helps prevent formation of blood clots, and its widespread use has probably been the cheapest breakthrough in the history of heart disease treatment.
A study five years ago by Dr. Mark McClellan, who was to become the commissioner of the Food and Drug Administration, and Dr. Paul A. Heidenreich of the Veterans Affairs Palo Alto Health Care System in California, estimated that growing aspirin use explained more than a third of the decrease in the death rates of heart attack victims from 1975 to 1995.
Still, a Duke University study of about 32,000 patients with coronary artery disease who were treated from 1995 to 2002 found that only 83 percent took aspirin. And only 71 percent did so consistently.
The financial incentives in the health care system are part of the problem, experts say. These incentives encourage hospitals and clinics to provide more services, hire more specialists and install more devices. They shuttle patients from one specialist to the other — providing more-scattered care. All too often, when the patient leaves the hospital, nobody among the crowd of doctors takes responsibility for prescribing the beta-blockers. “The system rewards throughput and higher-margin services,” Dr. Fisher said. “This leads us inadvertently to waste and inadvertently to harm.”
He argued that hospitals and doctors must gather into bigger units that coordinate care smoothly — sharing medical records and responsibility for a patient’s overall health. They should provide information about treatments and outcomes. And, he said, Medicare must start paying for results, measured in terms of lives improved and extended and of value for the money.
Congress has taken a step in this direction. But changing entrenched practices is not easy.
MR. SKINNER and Mr. Staiger found an odd pattern in the regional propensities of doctors to prescribe beta blockers: it closely matched the propensities of farmers to embrace hybrid corn early in the 20th century.
Hybridization spread through Iowa’s cornfields as early as the mid-1930s. By contrast, in Alabama and Georgia it didn’t take hold until the late 1940s. In other words, the lag in the prescription of beta blockers is not simply a problem of the health care system. It also reflects regional attitudes about the adoption of new technologies, the study concluded. That problem could take generations to solve.
Sunday, December 03, 2006
Healthcare Pricing
PLEASE VISIT MY BLOG AT http://floridadocs.blogspot.com FOR A COMPLETE LISTING OF ALL ARTICLES AND E-MAILS.
Dear Friends and Colleagues:
Attached an article from todays Miami Herald discussing the issue of healthcare pricing. According to the reporter many health insurers and governments are already charging ahead to make information about hospital and doctor quality performance available to the public, but many believe the biggest push -- and the biggest battleground -- will be the revelation of healthcare pricing. It sis true that at the moment, healthcare prices are so convoluted that even experts struggle to make sense of them.At some point, however, this abstract knowledge will be used for specific economic ends. Insurers are already calculating the costs of care and comparing it with the quality of a provider's care. Some even start steering customers towards doctors who provide "cheaper"care by rewarding customers financially.
Even though I am supporting transparency in healthcare pricing and the patients right to receive high-quality care, I am concerned that insurers may just focus on cheaper and not necessarily better care.
This in the end will reward those docs that lowball others and comply with checklists and protocols to maintain their competitive edge.
The patients choice in physicians selection will thereby severely hampered.
Yours
Bernd
Posted on Sun, Dec. 03, 2006
HEALTHCARE | THIRD IN AN OCCASIONAL SERIES
Lifting veil on healthcare costs
Exposing the super-secret lists of healthcare pricing could lead to huge changes -- and give consumers a real understanding of the true costs of their treatment.
BY JOHN DORSCHNER
jdorschner@MiamiHerald.com
At Broward General or Mercy Hospital, a coronary bypass operation can be expected to cost $30,909 to $43,407. At Baptist Hospital, the cost is likely to be far more -- $43,070 to $58,271, according the health insurer Cigna.
For women ages 40-64 insured by Aetna, gynecologist Moises Lichtinger in Fort Lauderdale charges $86.93 for a comprehensive exam. In Miami Beach, gynecologist Pedro J. Brasac charges $106.99.
For the first time, insurers are starting to reveal some of the most deeply held secrets of healthcare -- what things really cost. Those revelations may ultimately change what providers charge -- and how much consumers pay.
''We're at the leading edge of a huge change,'' says Brian Klepper of the Center for Practical Health Reform.
Many health insurers and governments are already charging ahead to make information about hospital and doctor quality performance available to the public, but many believe the biggest push -- and the biggest battleground -- will be the revelation of healthcare pricing.
At the moment, healthcare prices are so convoluted that even experts struggle to make sense of them.
The list of prices for Baptist Hospital, for example, is contained in a foot-thick document called a chargemaster. No outsider is allowed to see it. What's more, virtually no one pays those prices. Medicare, Medicaid and consumers with private health plans all pay negotiated rates that may be only a third of the official prices. That means only those without insurance get hit with a full-price bill.
Uwe Reinhardt, the widely respected healthcare economist at Princeton, compares present hospital pricing to entering a department store blindfolded and shopping for a ``clothes benefit program.''
''Only months after a shopping trip would the employee receive . . . a statement explaining how much the employee had to pay for whatever he or she had stuffed, blindfolded, into the shopping cart,'' wrote Reinhardt in the January/February issue of Health Affairs.
That meant the department store/hospital had finally presented its charges, and the insurer then decided what was a ''reasonable'' rate for those charges that it deemed appropriate. Finally, the customer is told to pay a certain percentage of that mysterious figure.
At present, persons with insurance generally don't care about this mysterious pricing. For that coronary by-pass surgery mentioned above, for example, the Cigna patient in one typical high-deductible plan would have an out-of-pocket expense of $3,000 at each facility, regardless of the cost.
Knowing prices now ''helps provide clarity on how much things cost,'' says Joe Mondy, a Cigna spokesman.
''The more people understand the cost of healthcare, the better off we will be,'' says Charles Cutler, national medical director for Aetna.
At some point, however, this abstract knowledge will be used for specific economic ends. Insurers are already calculating the costs of care and comparing it with the quality of a provider's care. ''That's going to start a huge shift,'' says Klepper of the Health Reform group.
The Bush administration in Washington and private insurers believe that hospitals and doctors who do the best in this quality-cost scenario should be rewarded with higher payments -- the so-called ``pay for performance.''
The flip side is steering consumers to those providers who provide quality efficiently. Cigna is already starting to do that, with its Cigna Care Network, made up of doctors who score well for quality and cost-efficiency. Starting in January in 58 markets (including South Florida), members who use the Cigna Care doctors will be rewarded by saving $10 to $30 per office visit.
Doctor quality by itself is a complex issue -- as The Miami Herald discussed in a report last Sunday -- but efficiency may be even more complicated.
Spokesmen for programs like Aetna's Aexcel, UnitedHealthcare's Premium Physicians and Cigna's Care Network insist that efficiency ratings are given only to those physicians who have already shown quality performance, but none of them go into detail about what makes for efficiency.
Theoretically, efficiency could mean keeping patients out of expensive emergency rooms or not requesting unnecessary tests and procedures, but in practice, doctors are suspicious that it might mean simple cost-cutting.
''You have to look very carefully at those efficiency numbers,'' says Nancy Nielsen, a Buffalo internist who's head of the American Medical Association's House of Delegates. ``Some are only about costs. That's where it gets tricky. That's where the biggest fights and negotiations are.''
The AMA is so concerned about insurers forming networks using efficiency measurements that its delegates, meeting in Las Vegas in November, passed a resolution seeking laws to prohibit insurers from creating networks ''based solely on economic criteria.'' Last week, the national organization of doctors joined its first lawsuit on the issue, against Regence BlueShield in Washington state. Insurers insist it won't be ''solely'' on costs, but they say something must be done about cost disparities, many of which have nothing to do with quality of care.
In South Florida, Aetna reports, the negotiated rates -- the real rates insurers pay -- vary widely right now. Knee arthroscopy in an orthopedist's office can cost from $1,922 to $4,000. For a hysteroscopy (the insertion of a small telescope to study a uterus) at an OB/GYN office, the price ranges from $1,200 to $4,756. For a heart catheterization, at a cardiology office, the price ranges from $600 to $2,500.
Of course, top doctors charging more might explain those variations, but what explains differences in radiology tests, such as a magnetic resonance imaging?
''These are commodities,'' says Mondy of Cigna. ''An MRI is an MRI is an MRI.'' But Cigna's studies show that their costs vary by an average of 30 percent.
An MRI without contrast agent at the Cleveland Clinic in Weston costs $400 in Cigna's negotiated fees. Broward General's price is $450. Hollywood Medical Center charges $660.
Some insurers are more focused on advising consumers about estimates for procedures -- without showing the differences between facilities. Blue Cross Blue Shield of Florida, for example, tells its members that coronary bypass surgery for a 45- to 64-year-old in Miami-Dade will cost $55,562 to $80,257 in network, $124,260 to $179,488 out of network, for everything including hospital, surgeon and related costs. In Broward, it would be a couple of thousand less.
A Florida government website also offers pricing information, but it is based on hospitals' gross charges, which persons rarely pay. Still, an uninsured person who is likely to be charged full fare can learn from the website (floridacomparecare.com) that for coronary bypass surgery at Baptist Hospital is $135,573, well below Broward General's $140,227 and Mercy's $154,261.
But the data of Cigna and other insurers reveal that Baptist, which has a near monopoly on the affluent area of southern Miami-Dade, is able to negotiate a much better deal for itself than the others can.
When it comes to real prices -- the negotiated rates -- Cigna pays Baptist about 35 percent of its full charges (around $47,500), while Broward General gets about 26 percent ($37,000) and Mercy receives about 24 percent ($37,000). And, as Cigna members are told on the insurer's website, the three hospitals are all ranked at the top level of three stars for the quality of patients' outcomes.
Eric Shatanof, vice president of Baptist Health South Florida, says that the price of one procedure, such as coronary bypass, doesn't mean that the Baptist hospitals (which include Doctors, South Miami and Homestead) are more expensive in all charges. ``Pricing is pretty complex. We could be more expensive on heart surgery and less expensive on something else.''
However, executives of four other insurers have told The Miami Herald that Baptist is consistently and considerably higher in its pricing. The executives don't want their names used because they don't want to anger the hospital system, which the insurers regard as crucial to maintaining customer satisfaction.
Shatanof acknowledges that ''our cost structure is quite a bit higher than our competitors. We have a higher clinical staffing ratio. We have higher investments, like the remote [intensive care unit] monitoring. So it's not necessarily apples to apples comparisons'' on quality and price.
But if insurers go to tier systems, in which consumers would have to pay more to go to higher-priced hospitals, ''it could change the mix,'' said Shatanof. ``Then you have to change the pricing.''
Dear Friends and Colleagues:
Attached an article from todays Miami Herald discussing the issue of healthcare pricing. According to the reporter many health insurers and governments are already charging ahead to make information about hospital and doctor quality performance available to the public, but many believe the biggest push -- and the biggest battleground -- will be the revelation of healthcare pricing. It sis true that at the moment, healthcare prices are so convoluted that even experts struggle to make sense of them.At some point, however, this abstract knowledge will be used for specific economic ends. Insurers are already calculating the costs of care and comparing it with the quality of a provider's care. Some even start steering customers towards doctors who provide "cheaper"care by rewarding customers financially.
Even though I am supporting transparency in healthcare pricing and the patients right to receive high-quality care, I am concerned that insurers may just focus on cheaper and not necessarily better care.
This in the end will reward those docs that lowball others and comply with checklists and protocols to maintain their competitive edge.
The patients choice in physicians selection will thereby severely hampered.
Yours
Bernd
Posted on Sun, Dec. 03, 2006
HEALTHCARE | THIRD IN AN OCCASIONAL SERIES
Lifting veil on healthcare costs
Exposing the super-secret lists of healthcare pricing could lead to huge changes -- and give consumers a real understanding of the true costs of their treatment.
BY JOHN DORSCHNER
jdorschner@MiamiHerald.com
At Broward General or Mercy Hospital, a coronary bypass operation can be expected to cost $30,909 to $43,407. At Baptist Hospital, the cost is likely to be far more -- $43,070 to $58,271, according the health insurer Cigna.
For women ages 40-64 insured by Aetna, gynecologist Moises Lichtinger in Fort Lauderdale charges $86.93 for a comprehensive exam. In Miami Beach, gynecologist Pedro J. Brasac charges $106.99.
For the first time, insurers are starting to reveal some of the most deeply held secrets of healthcare -- what things really cost. Those revelations may ultimately change what providers charge -- and how much consumers pay.
''We're at the leading edge of a huge change,'' says Brian Klepper of the Center for Practical Health Reform.
Many health insurers and governments are already charging ahead to make information about hospital and doctor quality performance available to the public, but many believe the biggest push -- and the biggest battleground -- will be the revelation of healthcare pricing.
At the moment, healthcare prices are so convoluted that even experts struggle to make sense of them.
The list of prices for Baptist Hospital, for example, is contained in a foot-thick document called a chargemaster. No outsider is allowed to see it. What's more, virtually no one pays those prices. Medicare, Medicaid and consumers with private health plans all pay negotiated rates that may be only a third of the official prices. That means only those without insurance get hit with a full-price bill.
Uwe Reinhardt, the widely respected healthcare economist at Princeton, compares present hospital pricing to entering a department store blindfolded and shopping for a ``clothes benefit program.''
''Only months after a shopping trip would the employee receive . . . a statement explaining how much the employee had to pay for whatever he or she had stuffed, blindfolded, into the shopping cart,'' wrote Reinhardt in the January/February issue of Health Affairs.
That meant the department store/hospital had finally presented its charges, and the insurer then decided what was a ''reasonable'' rate for those charges that it deemed appropriate. Finally, the customer is told to pay a certain percentage of that mysterious figure.
At present, persons with insurance generally don't care about this mysterious pricing. For that coronary by-pass surgery mentioned above, for example, the Cigna patient in one typical high-deductible plan would have an out-of-pocket expense of $3,000 at each facility, regardless of the cost.
Knowing prices now ''helps provide clarity on how much things cost,'' says Joe Mondy, a Cigna spokesman.
''The more people understand the cost of healthcare, the better off we will be,'' says Charles Cutler, national medical director for Aetna.
At some point, however, this abstract knowledge will be used for specific economic ends. Insurers are already calculating the costs of care and comparing it with the quality of a provider's care. ''That's going to start a huge shift,'' says Klepper of the Health Reform group.
The Bush administration in Washington and private insurers believe that hospitals and doctors who do the best in this quality-cost scenario should be rewarded with higher payments -- the so-called ``pay for performance.''
The flip side is steering consumers to those providers who provide quality efficiently. Cigna is already starting to do that, with its Cigna Care Network, made up of doctors who score well for quality and cost-efficiency. Starting in January in 58 markets (including South Florida), members who use the Cigna Care doctors will be rewarded by saving $10 to $30 per office visit.
Doctor quality by itself is a complex issue -- as The Miami Herald discussed in a report last Sunday -- but efficiency may be even more complicated.
Spokesmen for programs like Aetna's Aexcel, UnitedHealthcare's Premium Physicians and Cigna's Care Network insist that efficiency ratings are given only to those physicians who have already shown quality performance, but none of them go into detail about what makes for efficiency.
Theoretically, efficiency could mean keeping patients out of expensive emergency rooms or not requesting unnecessary tests and procedures, but in practice, doctors are suspicious that it might mean simple cost-cutting.
''You have to look very carefully at those efficiency numbers,'' says Nancy Nielsen, a Buffalo internist who's head of the American Medical Association's House of Delegates. ``Some are only about costs. That's where it gets tricky. That's where the biggest fights and negotiations are.''
The AMA is so concerned about insurers forming networks using efficiency measurements that its delegates, meeting in Las Vegas in November, passed a resolution seeking laws to prohibit insurers from creating networks ''based solely on economic criteria.'' Last week, the national organization of doctors joined its first lawsuit on the issue, against Regence BlueShield in Washington state. Insurers insist it won't be ''solely'' on costs, but they say something must be done about cost disparities, many of which have nothing to do with quality of care.
In South Florida, Aetna reports, the negotiated rates -- the real rates insurers pay -- vary widely right now. Knee arthroscopy in an orthopedist's office can cost from $1,922 to $4,000. For a hysteroscopy (the insertion of a small telescope to study a uterus) at an OB/GYN office, the price ranges from $1,200 to $4,756. For a heart catheterization, at a cardiology office, the price ranges from $600 to $2,500.
Of course, top doctors charging more might explain those variations, but what explains differences in radiology tests, such as a magnetic resonance imaging?
''These are commodities,'' says Mondy of Cigna. ''An MRI is an MRI is an MRI.'' But Cigna's studies show that their costs vary by an average of 30 percent.
An MRI without contrast agent at the Cleveland Clinic in Weston costs $400 in Cigna's negotiated fees. Broward General's price is $450. Hollywood Medical Center charges $660.
Some insurers are more focused on advising consumers about estimates for procedures -- without showing the differences between facilities. Blue Cross Blue Shield of Florida, for example, tells its members that coronary bypass surgery for a 45- to 64-year-old in Miami-Dade will cost $55,562 to $80,257 in network, $124,260 to $179,488 out of network, for everything including hospital, surgeon and related costs. In Broward, it would be a couple of thousand less.
A Florida government website also offers pricing information, but it is based on hospitals' gross charges, which persons rarely pay. Still, an uninsured person who is likely to be charged full fare can learn from the website (floridacomparecare.com) that for coronary bypass surgery at Baptist Hospital is $135,573, well below Broward General's $140,227 and Mercy's $154,261.
But the data of Cigna and other insurers reveal that Baptist, which has a near monopoly on the affluent area of southern Miami-Dade, is able to negotiate a much better deal for itself than the others can.
When it comes to real prices -- the negotiated rates -- Cigna pays Baptist about 35 percent of its full charges (around $47,500), while Broward General gets about 26 percent ($37,000) and Mercy receives about 24 percent ($37,000). And, as Cigna members are told on the insurer's website, the three hospitals are all ranked at the top level of three stars for the quality of patients' outcomes.
Eric Shatanof, vice president of Baptist Health South Florida, says that the price of one procedure, such as coronary bypass, doesn't mean that the Baptist hospitals (which include Doctors, South Miami and Homestead) are more expensive in all charges. ``Pricing is pretty complex. We could be more expensive on heart surgery and less expensive on something else.''
However, executives of four other insurers have told The Miami Herald that Baptist is consistently and considerably higher in its pricing. The executives don't want their names used because they don't want to anger the hospital system, which the insurers regard as crucial to maintaining customer satisfaction.
Shatanof acknowledges that ''our cost structure is quite a bit higher than our competitors. We have a higher clinical staffing ratio. We have higher investments, like the remote [intensive care unit] monitoring. So it's not necessarily apples to apples comparisons'' on quality and price.
But if insurers go to tier systems, in which consumers would have to pay more to go to higher-priced hospitals, ''it could change the mix,'' said Shatanof. ``Then you have to change the pricing.''
Prescription Drug Abuse
Dear Friends and Colleagues:
Attached an article from today’s Sun Sentinel highlighting the rampant use of prescription painkillers in Florida.
In the absence of any statewide prescription drug tracking system doctors and pharmacists often have to rely on their best judgment to fill or refill narcotics.
The article states that –“as of June, 32 states had adopted prescription-tracking programs to curb problems such as those in Florida, the most populous state without such a law.”
Furthermore the article correctly reports that – “despite the known dangers, Florida lacks a system for tracking prescription drugs. That, according to law enforcement officials, makes it a haven for addicts and "pill mills," where doctors churn out prescriptions without thoroughly examining patients.”
The Florida Medical Association in cooperation with the State Attorneys Office has released a comprehensive guide for physicians on how to diagnose, manage and treat patients with acute and chronic pain.
I want to EMPHASIZE that the MAJORITY of physician are prescribing narcotic pain medications in a responsible and professional manner!!!!
Nevertheless,we need to continue taking a proactive stand against unethical and unscrupulous “physicians”, who churn out prescriptions for their own financial gain. Those so-called “Pain Management “clinics are sprouting like mushrooms all over the State often owned and operated by doctors, who have little or no special training in pain management. Contrary to common belief these “doctors” are not being duped by patients to write prescriptions or trying to help patient suffering from pain. These “doctors” abuse their prescribing privileges to issue THOUSANDS or highly addictive opioids for ANYONE who pays. These “doctors” are driven by profits and not by the motivation to help patients. We need to protect our profession and point out those drug dealers in white coats and at the same time support legislation creating a statewide prescription pain medication-monitoring program.
Bernd Wollschlaeger,MD,FAAFP
Alarm in South Florida over prescription drug trade
Deaths skyrocket as dealers and addicts flock to S. Florida.
By Vanessa Blum
South Florida Sun-Sentinel
December 3, 2006
Out-of-state drug dealers and addicts are traveling long distances to visit Florida pain clinics, targeting the state because its lax oversight of prescription drugs makes scoring pills easier.
The unwanted tourism alarms state officials who have watched deaths from prescription pain medication skyrocket in recent years. In 2005, such prescription drugs as hydrocodone, methadone and oxycodone contributed to more overdose deaths than all other narcotics combined, according to Florida medical examiners.
Despite the known dangers, Florida lacks a system for tracking prescription drugs. That, according to law enforcement officials, makes it a haven for addicts and "pill mills," where doctors churn out prescriptions without thoroughly examining patients.
The problem was noted in a national drug threat assessment released Nov. 15 by the U.S.Department of Justice. The report outlined the "drug run" phenomenon in South Florida, saying residents of states with prescription monitoring "have in some cases turned to traveling to nearby states ... to illegally obtain pharmaceuticals."
That was the case for more than two dozen people from Kentucky who drove 1,000 miles each way to see doctors in Palm Beach County and Fort Lauderdale. They came by the van-load throughout 2005 and early 2006, returning with doses of OxyContin, Endocet, Percocet, Methadose -- drugs that were more difficult to get at home, according to federal prosecutors.
Eight people involved in the trips pleaded guilty to drug-trafficking charges in Palm Beach federal court, and several more are being tried in Kentucky state courts for alleged drug-related crimes.
The Fort Lauderdale medical office that supplied some of their prescriptions also is being investigated.
Drugs prescribed by Florida doctors caused the deaths of five people in Kentucky, according to prosecutors. One man died from a fatal overdose during the 18-hour drive home.
"We've seen people coming from all over the Southeast United States," said Rick Zenuch, an agent with the Florida Department of Law Enforcement who monitors drug-related trends. "The fact is, illicit drug traffickers don't see state lines as any boundary."
As of June, 32 states had adopted prescription-tracking programs to curb problems such as those in Florida, the most populous state without such a law.
While each system follows slightly different rules, their primary goal is to identify forged prescriptions and to expose so-called doctor shoppers who visit multiple physicians and pharmacies seeking drugs.
The programs generally require doctors to submit information on prescriptions to a centralized database. When an order is filled, the pharmacist also sends an electronic record.
If a doctor or pharmacist were to notice anything amiss in a patient's file, they could contact law enforcement or state health officers.
Kentucky's system is a model for other jurisdictions. Its effectiveness drove illicit drug seekers to surrounding states like Indiana, Ohio, Virginia and West Virginia. Each, in turn, created tracking programs, said Danna Droz, a former administrator of Kentucky's system.
In 2004, Florida's Legislature seemed poised to jump on the bandwagon. OxyContin manufacturer Purdue Pharma agreed to pay the state $2 million to cover start-up costs. But key legislators blocked a vote on the proposal citing its annual $2.8 million price tag and patient privacy considerations.
Dr. Rafael Miguel, a professor of pain medicine at the University of South Florida, called the inaction "infuriating and depressing."
"You have to provide Florida doctors with tools so they can safely prescribe these medications and know they're in the right hands," Miguel said. "Right now doctors are being made unwilling and unknowing participants in the drug trade."
A similar proposal languished and died this year as the legislature focused on other issues. Drug enforcers like Bill Janes, director of the Florida Office of Drug Control, vow to continue their push. Janes said working with lawmakers to pass a prescription-tracking program is his top priority for the new legislative session.
Soon legislators may have no choice. Under a federal law passed in 2006, states that do not implement prescription-tracking within three years will take a backseat for federal funding of drug-related programs.
A prescription tracking system is not a cure-all, Janes said, but could help prevent doctors and pharmacists from unwittingly aiding addicts and drug dealers. Moreover, if criminal activity were suspected, police could get evidence much more quickly.
"It would be a first step," Janes said. "Certainly the opportunity to obtain illegal drugs is much higher if you don't have this."
Maureen Barrett of Fort Lauderdale will support those efforts. She lost her son to a painkiller overdose in 2002 and thinks prescription monitoring might have saved his life.
Drew Parkinson, a student at Florida Atlantic University, received prescriptions for 1,455 pills in 57 days. He died at 25, two days after picking up his final doses.
"Somewhere along the line, a red flag should have come up so they wouldn't have kept giving him the pills," Barrett said.
Privacy concerns cited by opponents are overblown, she added.
"If you go to CVS or Walgreens they have a complete list of all the medicine you've gotten," Barrett said. "We have laws in place to make sure that information is not disseminated."
Dr. Robert Yezierski, director of University of Florida's Comprehensive Center for Pain Research, isn't convinced. He said prescription-tracking is "a good idea in theory," but people who want to abuse the system will find a way.
"What we don't want to do is deny treatment to people who legitimately need pain medication," Yezierski said.
Pain relievers such as methadone and oxycodone -- both chemically altered opioids similar to heroin -- are among the most commonly abused prescription drugs. According to a report published by the Florida Department of Law Enforcement, methadone caused 620 Florida deaths in 2005 -- either alone or in combination with other drugs. The report listed oxycodone as the cause of 340 fatal overdoses.
Used at recommended doses, oxycodone is a powerful treatment for pain and is often prescribed to cancer patients. The drug also is highly addictive and dangerous when taken in large quantities or mixed with alcohol.
Oxycodone tablets sell on the street for about $1 per milligram -- almost 10 times what they cost at a pharmacy.
The Kentucky group frequented clinics in Broward and Palm Beach counties. Some pills went to feed their own addictions, prosecutors and law enforcement say. Others they sold on the street or to friends and neighbors in their small towns near Lexington.
Kentucky law enforcement alerted the Drug Enforcement Administration after a number of overdoses were linked to Florida prescriptions. The individuals charged in federal court range in age from 21 to 64 and face sentences of about four to nine years.
So far, no physicians have been charged in the connection with the case.
In May, federal agents raided the offices of a Fort Lauderdale pain clinic where some Kentucky travelers received prescriptions.
Kentucky grandmother Jewel Padgett, 64, was among those prescribed pills by physicians at the AMMA Pain Care Center in Fort Lauderdale, according to her attorney.
She pleaded guilty to four felonies connected to her Florida trips, including conspiracy to distribute controlled substances and traveling across state lines to promote drug trafficking.
Government lawyers contend Padgett organized and paid for many of the trips from Kentucky in exchange for a portion of the others' pills, earning roughly $30,000.
Padgett's son said his mother went to Florida because she couldn't find a doctor in Kentucky willing to treat neck and back pain caused by a 1998 car accident.
"They wouldn't give her medication she needed," said Don Padgett. "They're scared up here. They got them so restricted."
Fort Lauderdale attorney Theresa Van Vliet, who represents AMMA, said her client supports prescription monitoring and hired a Tallahassee lobbyist earlier this year to push the measure.
"They think it's a good thing," Van Vliet said of her clients. "Pain management is a very new medical field and it is one that clearly can be manipulated."
Van Vliet declined to discuss the Kentucky cases, citing medical privacy laws.
She said AMMA physicians are told to verify medical reports before prescribing pain medication and discouraged from treating out-of-state patients. "It's not foolproof," Van Vliet said, "but nothing is foolproof."
Vanessa Blum can be reached at vbblum@sun-sentinel.com or 954-356-4605.
Attached an article from today’s Sun Sentinel highlighting the rampant use of prescription painkillers in Florida.
In the absence of any statewide prescription drug tracking system doctors and pharmacists often have to rely on their best judgment to fill or refill narcotics.
The article states that –“as of June, 32 states had adopted prescription-tracking programs to curb problems such as those in Florida, the most populous state without such a law.”
Furthermore the article correctly reports that – “despite the known dangers, Florida lacks a system for tracking prescription drugs. That, according to law enforcement officials, makes it a haven for addicts and "pill mills," where doctors churn out prescriptions without thoroughly examining patients.”
The Florida Medical Association in cooperation with the State Attorneys Office has released a comprehensive guide for physicians on how to diagnose, manage and treat patients with acute and chronic pain.
I want to EMPHASIZE that the MAJORITY of physician are prescribing narcotic pain medications in a responsible and professional manner!!!!
Nevertheless,we need to continue taking a proactive stand against unethical and unscrupulous “physicians”, who churn out prescriptions for their own financial gain. Those so-called “Pain Management “clinics are sprouting like mushrooms all over the State often owned and operated by doctors, who have little or no special training in pain management. Contrary to common belief these “doctors” are not being duped by patients to write prescriptions or trying to help patient suffering from pain. These “doctors” abuse their prescribing privileges to issue THOUSANDS or highly addictive opioids for ANYONE who pays. These “doctors” are driven by profits and not by the motivation to help patients. We need to protect our profession and point out those drug dealers in white coats and at the same time support legislation creating a statewide prescription pain medication-monitoring program.
Bernd Wollschlaeger,MD,FAAFP
Alarm in South Florida over prescription drug trade
Deaths skyrocket as dealers and addicts flock to S. Florida.
By Vanessa Blum
South Florida Sun-Sentinel
December 3, 2006
Out-of-state drug dealers and addicts are traveling long distances to visit Florida pain clinics, targeting the state because its lax oversight of prescription drugs makes scoring pills easier.
The unwanted tourism alarms state officials who have watched deaths from prescription pain medication skyrocket in recent years. In 2005, such prescription drugs as hydrocodone, methadone and oxycodone contributed to more overdose deaths than all other narcotics combined, according to Florida medical examiners.
Despite the known dangers, Florida lacks a system for tracking prescription drugs. That, according to law enforcement officials, makes it a haven for addicts and "pill mills," where doctors churn out prescriptions without thoroughly examining patients.
The problem was noted in a national drug threat assessment released Nov. 15 by the U.S.Department of Justice. The report outlined the "drug run" phenomenon in South Florida, saying residents of states with prescription monitoring "have in some cases turned to traveling to nearby states ... to illegally obtain pharmaceuticals."
That was the case for more than two dozen people from Kentucky who drove 1,000 miles each way to see doctors in Palm Beach County and Fort Lauderdale. They came by the van-load throughout 2005 and early 2006, returning with doses of OxyContin, Endocet, Percocet, Methadose -- drugs that were more difficult to get at home, according to federal prosecutors.
Eight people involved in the trips pleaded guilty to drug-trafficking charges in Palm Beach federal court, and several more are being tried in Kentucky state courts for alleged drug-related crimes.
The Fort Lauderdale medical office that supplied some of their prescriptions also is being investigated.
Drugs prescribed by Florida doctors caused the deaths of five people in Kentucky, according to prosecutors. One man died from a fatal overdose during the 18-hour drive home.
"We've seen people coming from all over the Southeast United States," said Rick Zenuch, an agent with the Florida Department of Law Enforcement who monitors drug-related trends. "The fact is, illicit drug traffickers don't see state lines as any boundary."
As of June, 32 states had adopted prescription-tracking programs to curb problems such as those in Florida, the most populous state without such a law.
While each system follows slightly different rules, their primary goal is to identify forged prescriptions and to expose so-called doctor shoppers who visit multiple physicians and pharmacies seeking drugs.
The programs generally require doctors to submit information on prescriptions to a centralized database. When an order is filled, the pharmacist also sends an electronic record.
If a doctor or pharmacist were to notice anything amiss in a patient's file, they could contact law enforcement or state health officers.
Kentucky's system is a model for other jurisdictions. Its effectiveness drove illicit drug seekers to surrounding states like Indiana, Ohio, Virginia and West Virginia. Each, in turn, created tracking programs, said Danna Droz, a former administrator of Kentucky's system.
In 2004, Florida's Legislature seemed poised to jump on the bandwagon. OxyContin manufacturer Purdue Pharma agreed to pay the state $2 million to cover start-up costs. But key legislators blocked a vote on the proposal citing its annual $2.8 million price tag and patient privacy considerations.
Dr. Rafael Miguel, a professor of pain medicine at the University of South Florida, called the inaction "infuriating and depressing."
"You have to provide Florida doctors with tools so they can safely prescribe these medications and know they're in the right hands," Miguel said. "Right now doctors are being made unwilling and unknowing participants in the drug trade."
A similar proposal languished and died this year as the legislature focused on other issues. Drug enforcers like Bill Janes, director of the Florida Office of Drug Control, vow to continue their push. Janes said working with lawmakers to pass a prescription-tracking program is his top priority for the new legislative session.
Soon legislators may have no choice. Under a federal law passed in 2006, states that do not implement prescription-tracking within three years will take a backseat for federal funding of drug-related programs.
A prescription tracking system is not a cure-all, Janes said, but could help prevent doctors and pharmacists from unwittingly aiding addicts and drug dealers. Moreover, if criminal activity were suspected, police could get evidence much more quickly.
"It would be a first step," Janes said. "Certainly the opportunity to obtain illegal drugs is much higher if you don't have this."
Maureen Barrett of Fort Lauderdale will support those efforts. She lost her son to a painkiller overdose in 2002 and thinks prescription monitoring might have saved his life.
Drew Parkinson, a student at Florida Atlantic University, received prescriptions for 1,455 pills in 57 days. He died at 25, two days after picking up his final doses.
"Somewhere along the line, a red flag should have come up so they wouldn't have kept giving him the pills," Barrett said.
Privacy concerns cited by opponents are overblown, she added.
"If you go to CVS or Walgreens they have a complete list of all the medicine you've gotten," Barrett said. "We have laws in place to make sure that information is not disseminated."
Dr. Robert Yezierski, director of University of Florida's Comprehensive Center for Pain Research, isn't convinced. He said prescription-tracking is "a good idea in theory," but people who want to abuse the system will find a way.
"What we don't want to do is deny treatment to people who legitimately need pain medication," Yezierski said.
Pain relievers such as methadone and oxycodone -- both chemically altered opioids similar to heroin -- are among the most commonly abused prescription drugs. According to a report published by the Florida Department of Law Enforcement, methadone caused 620 Florida deaths in 2005 -- either alone or in combination with other drugs. The report listed oxycodone as the cause of 340 fatal overdoses.
Used at recommended doses, oxycodone is a powerful treatment for pain and is often prescribed to cancer patients. The drug also is highly addictive and dangerous when taken in large quantities or mixed with alcohol.
Oxycodone tablets sell on the street for about $1 per milligram -- almost 10 times what they cost at a pharmacy.
The Kentucky group frequented clinics in Broward and Palm Beach counties. Some pills went to feed their own addictions, prosecutors and law enforcement say. Others they sold on the street or to friends and neighbors in their small towns near Lexington.
Kentucky law enforcement alerted the Drug Enforcement Administration after a number of overdoses were linked to Florida prescriptions. The individuals charged in federal court range in age from 21 to 64 and face sentences of about four to nine years.
So far, no physicians have been charged in the connection with the case.
In May, federal agents raided the offices of a Fort Lauderdale pain clinic where some Kentucky travelers received prescriptions.
Kentucky grandmother Jewel Padgett, 64, was among those prescribed pills by physicians at the AMMA Pain Care Center in Fort Lauderdale, according to her attorney.
She pleaded guilty to four felonies connected to her Florida trips, including conspiracy to distribute controlled substances and traveling across state lines to promote drug trafficking.
Government lawyers contend Padgett organized and paid for many of the trips from Kentucky in exchange for a portion of the others' pills, earning roughly $30,000.
Padgett's son said his mother went to Florida because she couldn't find a doctor in Kentucky willing to treat neck and back pain caused by a 1998 car accident.
"They wouldn't give her medication she needed," said Don Padgett. "They're scared up here. They got them so restricted."
Fort Lauderdale attorney Theresa Van Vliet, who represents AMMA, said her client supports prescription monitoring and hired a Tallahassee lobbyist earlier this year to push the measure.
"They think it's a good thing," Van Vliet said of her clients. "Pain management is a very new medical field and it is one that clearly can be manipulated."
Van Vliet declined to discuss the Kentucky cases, citing medical privacy laws.
She said AMMA physicians are told to verify medical reports before prescribing pain medication and discouraged from treating out-of-state patients. "It's not foolproof," Van Vliet said, "but nothing is foolproof."
Vanessa Blum can be reached at vbblum@sun-sentinel.com or 954-356-4605.
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