Greetings dear readers!

By now tens of thousands of you, (or at least a short conga line's worth),  will have noticed that I've been missing for a week or two.  Alas, like this donkey I've been temporarily overwhelmed.  The good news is that the the rush to complete the final edits on my book is almost complete.  Actual production process is slated to begin shortly at Prentice Hall. 

(In the process the title has now been changed to "Stop the Bleeding: How to Save Trillions by Overhauling America's Healthcare Machine".  Oh those wily marketing people!)

Regardless of what it's called, the basis of the book - that American healthcare is being overwhelmed by thoughtless, expensive and quality-sucking bureaucratic complexity - is truer than ever.  The passage of the 2,400+ page Obamacare legislation has only accelerated the process.  We have a short window of opportunity to fix things before the medical, social and financial consequences of poor planning and administrative mis-management come crashing down upon us.  The irony is that the solutions are so much easier and cheaper than what we're doing now! 

It brings to mind the adage about hitting oneself repeatedly with a hammer because it feels so good when you stop.  The big question is whether we can muster the common sense and political will to quit hurting ourselves and future generations?

At any rate, I should be back blogging about the Road to Hellth just after August 7th or so.  There will be tons to catch up on. 

Look forward to seeing you then!

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In a classic Ten Commandments moment, the Department of Health and Human Services released its final version of the rules regarding the "Meaningful Use" of healthcare information technology (HIT).  Meaningful use entered our vocabulary in early 2009 as part of a $20+ billion gift from doctors, hospitals and the taxpayers to the needy folks at Cerner, GE, Siemens, Allscripts, Epic and other purveyors of complex, expensive and difficult-to-use and potentially even dangerous medical software products.  Dr. Scot Silverstein has written some excellent posts here, here and here about the problems increasingly caused by the HHS/HIT-Industrial Complex, and anyone interested in the greater good of economic efficiency and patient care should spend some time reviewing his articles and websites. 

As our non-medical readers may or may not know, in 2009 President Obama and the Democratic Party majority in Congress passed "economic stimulus" legislation that called for doctors and hospitals to suddenly rapidly massive numbers of complex and expensive electronic medical records and computerized ordering systems.  The law created a "play-or-be-punished" program.  Doctors and hospitals who handed their own money over to Cerner, GE, Allscripts, Epic and a few other large vendors early on (i.e., before 2014), would be eligible to receive federal rebates.  (These rebates consist of money that our Federal government has presumably borrowed from China for this purpose.)  On the other hand, if these same providers persisted in not handing their money over to the HIT industry after 2015, Medicare would cut their payments for delivering actual patient care by 1% each year (1% in the first year, 2% in the second year, and so on), until they did. 

This may not seem like much as financial penalties go, but that's how it's supposed to look to the average person.  As explained here in a previous post, these sorts of reductions in gross income turn out to be twice as big in terms of their reduction in net provider income.  In other words, a 5% reduction in gross Medicare payments actually traslates into a 10% reduction in take-home pay. 

Yes, your doctor could be providing top quality care, making diagnoses everyone else has missed, be saving millions in healthcare costs and finding the cure for cancer.  But if she is not using a governement-sactioned piece of software in a certain sort of way, then *thwack!*, off with her mortgage payments!

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Dr. James Gault's Retired Doc's Thoughts blog has an excellent post today about the abrupt recess appointment of Dr. Don Berwick as the head of The Center for Medicare Services.  The post points out that Dr. Berwick appears to express contradictory views about society's need to ration and the individual's desire to have whatever the heck they want in the way of medical care, whenever the heck they want it. 

It should be a grave disappointment to all of us that Dr. Berwick, (possibly the first pediatrician ever to be placed in charge of healthcare for the elderly), was never asked or allowed to explain his perspectives and approach to managing Medicare and Medicaid to the American public prior to his appointment. For all practical purposes the appointment was made "in the dead of night", and in a way specifically designed to hide Dr. Berwick and his views from public scrutiny.

As detailed here, President Obama's comments about making the recess appointment as a way to circumvent Republican delays are disingenuous at best.

Of course, recess appointments have been made before by Presidents of both parties.  But this has almost always been done after hearings and after the opposing party has actually engaged in some sort of obstruction or delaying tactics.  A pre-emptive recess appointment by a President whose party deliberately shielded the candidate from public scrutiny is a different animal altogether.  It should be nothing less than disgraceful from a political leader who pledged on the record  that:

"My Administration is committed to creating an unprecedented level of openness in Government.  We will work together to ensure the public trust and establish a system of transparency, public participation, and collaboration. Openness will strengthen our democracy and promote efficiency and effectiveness in Government."

Deliberately avoinding hearings through back-door appointments does nothing to earn the public's trust.  In fact, it should have the affect of making us all very, very wary.

 

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Thinking is hard work.  This is why so few people bother.  At least voluntarily.  So whenever it seems like the threat of brainwork looms in modern American medicine, we can thank our lucky stars for the geniuses behind healthcare “reform” and guidelines of care.

This comes up as a result of a conversation that I had with a patient the other day.  A pleasant, obese gentleman.  He had been struggling with his weight and Type II diabetes for some time, and there were now some early indications of some potentially serious long-term complications.  He mentioned to me that he was working hard to prepare for gastric bypass surgery.   I asked him how he was doing that.

“Why, by eating!” he replied.  Huh?  By eating?

“Oh yes”, he explained.  “You see, I’m getting these complications from my weight and diabetes and all of my doctors think that I’m an excellent candidate for weight loss surgery.  Based on my previous weights, if I can just get lose about 40 or 50 pounds, I should have much better blood sugars and need far less insulin.  God, that stuff is expensive when you’re using hundreds of units per day!”

That sounded perfectly reasonable.  This gentleman is a walking advertisement for the virtues of slimming down.  And for gastric bypass, in fact.  So why is he holding that venti whole milk mocha with 508 calories and 27 grams of fat?

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If you kidnap someone and no one notices, is it really a hostage-taking?

This is the dilemma currently facing House Speaker Nancy Pelosi.  You have to be sympathetic to her plight.  As we described in our last post, Ms. Pelosi “saw no reason” for the House of Representatives to vote on a Senate measure that would have prevented Medicare doctors from having the net income that they receive from Medicare and TRICARE cut by 43%.  (TRICARE takes care of the families of our military servicemen and women, and bases its own rates on Medicare. However it pays even less than Medicare in most cases.) 

Her clearly stated rationale was that, by threatening to bankrupt doctors taking care of the elderly, she could force the Senate to vote for additional unfunded billions of dollars in unemployment benefits:

"The inadequate legislation on physicians' fees that Senate Republicans allowed to pass today is a great disappointment.  The House has approved long-term reform that ensures that Medicare patients will have access to quality physicians' services.

"The bill Senate Republicans allowed to pass is not only inadequate with respect to physician fees, but it ignores urgent sections of the House bill to provide jobs.  The House has repeatedly sent jobs-creating bills to the Senate since December -- Build America Bonds, small business hiring incentives, and importantly, summer jobs -- and yet Republicans continue to block approval of jobs legislation.

“What is it that Republicans in the Senate and House don't understand about the need for jobs in America?

"I see no reason to pass this inadequate bill until we see jobs legislation coming out of the Senate.  House Democrats are saying to Republicans in the Senate: Show us the jobs!"

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If there were any lingering doubts that the our elected officials are too irresponsible, petty and incompetent to be allowed to run something as important as healthcare, they’re now a thing of the past.  If you’ve not been following the saga of the “doc fix” in Congress recently, then you should be – even if you’re not elderly or a healthcare provider.  Why?  Because it’s the best available indicator of how our political Leaders are going to be managing the rest of the healthcare market under the law popularly known as Obamacare. 

The story goes like this:

In 1997, Congress passed a law that says that the rate of growth in Medicare spending can grow no faster than the gross domestic product, even though there is absolutely no reason why the two should have anything to do with one another.  If it does, doctors will be arbitrarily penalized by cutting the fees they get for providing healthcare services to Medicare patients.

Every year for the past 13 years, the rate of growth in Medicare spending exceeds the rate of growth in GDP.  And nearly every year, Congress has said “Gosh, that was a terrible law we passed.  We don’t really want doctors to have their payments cut and force them to stop seeing Medicare patients.”  But rather than eliminating the law, Congress has passed a short-term band-aid that restores physician payments for a year or so.  Meanwhile, the cuts became cumulative. As of this year they add up to 21.5% reduction in physician payments.

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