Round-up of ‘Getting Better Healthcare’ programs

Make sure you check out the Getting Better Health Care Radio Program on webtalkradio.net. My latest interview is with Dr. Nancy Oriol, founder of the award winning Family Van program in Boston. She tells us about the barriers to accessing our health care system and how reaching out to the community can help reduce those barriers.

Want to reduce your health care costs? Don’t miss my interview with Dr. Cynthia Koelker, author of 101 Ways to Save Money on Healthcare.   She tells us how we can save money on preventive care, including information on which screening tests we need and which we don’t.

The previous show with David Coates talks about the politics of making needed changes in our health care system.

Another show not to be missed is the interview with Dr. Sandra Kweder, Deputy Director of the Office of New Drugs in the FDA’s Center for Drug Evaluation and Research.  She explains what the FDA does to assure that marketed drug products are effective and safe.

Read Full Post »

The Berwick appointment to CMS

President Obama appointed Dr. Donald Berwick to be the administrator of The Centers for Medicare & Medicaid Services (CMS) through a recess appointment that avoided a Congressional hearing.

Who is Donald Berwick? I’ve been hearing about him for years. He founded and led the Institute for Healthcare Improvement (IHI), a not-for-profit organization that has been pioneering efforts to improve of health care in the United States and elsewhere. His efforts have helped steer the U.S. health care system toward a greater recognition of the need to achieve health care excellence and, more importantly, have resulted in real, practical successes that have improved the care we receive in the U.S. health care system.

Some of Berwick’s detractors with respect to this appointment focus on statements he has made about rationing care and redistributing it to the people who need it most. Let me be very clear: health care will be rationed. It already is now, and the only question facing us as we try to address the spiraling cost of care is who will do the rationing in the future. Will we Americans choose to take responsibility to do it ourselves (by taking more responsibility for directly paying the cost of care), or will we leave it to insurers, politicians and other government regulators to do it for us?

So far it seems we don’t have the stomach to ration care ourselves, though I believe that increasing personal responsibility is the best way to control health care expenditures. If we are going to leave it to the government to control our health care costs, we could do a lot worse than having Don Berwick at the helm.

Read Full Post »

Massachusetts and national health care reform

In a July 19 article, Washington Post columnist Robert Samuelson describes Massachusetts health care reform measures as a model for the national health care legislation that passed Congress this year. He doesn’t paint a hopeful picture. True, marginally more people gained access to care — defined by having insurance coverage. But costs continue to spiral out of control.

The measures to control costs have been limited and largely ineffective. Wholesale changes in how doctors and hospitals would be paid were suggested, but without any specific plans. In Samuelson’s words, “The system’s fundamental incentives won’t change.” He raises the possibility of unpopular measures such as “accountable care organizations” or spending restrictions that would limit consumer choice of doctors and hospitals or raise the specter of essential care denied.

Samuelson leaves out the other path, the one that has been so successful in so much of the rest of the U.S. economy, a market-based approach in which consumers get to choose what care they want, but they must also face the economic impact of those choices. For more details, visit http://www.drscore.com and check out my White Paper on Health Care Reform.

Read Full Post »

Improving access to preventive care services

One way that recent health care reform legislation is supposed to help improve care while lowering costs is by encouraging more preventive care services to be offered. The Center for Medicare & Medicaid Services (CMS) announced new preventive health benefits created under the Affordable Care Act for seniors and persons with disabilities covered by Medicare.

Click here to learn more about these benefits.

Read Full Post »

Understanding the drug company perspective

While drug companies make the innovative products that help improve and save lives, these companies also get a bad rap. Pharmaceutical companies are responsible for modern-day medications that let doctors work miracles. Is there a downside, too?

To understand the industry perspective, I spoke with Lori Reilly, Vice President for Policy and Research at the Pharmaceutical Research and Manufacturers of America (PHRMA) on Getting Better Health Care.

Read Full Post »

Avandia in the news

Avandia, a medicine used to treat diabetes, has been the subject of news and controversy. Concerns have been raised about the drug potentially causing an increased risk of heart attacks compared to other treatment options. An FDA panel reviewed the evidence and voted 20-12 to keep Avandia on the market.

The controversy around Avandia is complicated. Concerns were expressed that the manufacturer may have downplayed or hidden evidence of problems with the drug. But so far, a detailed examination of the evidence didn’t lead the FDA panel to call for sales of the drug to stop.

In some of the latest news about the controversy, a couple of members of the FDA panel that reviewed the drug were found to have been paid in the past for services to the company that makes Avandia or by the company that makes the competing product (Wall Street Journal). I doubt this affected the panel deliberations or decision in any substantive way.

The bottom line is that understanding the safety of drug products is really quite difficult. In the case of Avandia, it’s easy (well, at least relatively easy) to show that the drug helps patients control their sugar level. It’s much harder to know if there’s a small increased risk of heart attacks or how big that small increased risk is. If you are taking Avandia, the best course is probably to speak to your doctor about it.

Read Full Post »

Sunshine is the best disinfectant

Campaign finance legislation failed to pass the Senate today.  Last year, U.S. Senators Chuck Grassley (R-IA) and Herb Kohl (D-WI) introduced legislation to require drug companies to publicly report money they give to doctors over $100 every year.

This is a wonderful idea. Greater transparency helps everyone.  At DrScore, this is a focus of our beliefs about U.S. medicine. Doctors have nothing to fear and much to gain from transparency, whether we talk about patient satisfaction scores or pharmaceutical company support. The last thing we doctors need to do is to raise suspicions by fighting efforts to improve transparency.

In fact, physicians should lead the way in support of more transparency.  Not only should we be supporting the Grassley/Kohl measure, but  we should encourage Congress to expand the measure to include payments to politicians and their campaign funds.  Senator Grassley hit the nail on the head when he said, “The goal of our legislation is to lay it all out, make the information available for everyone to see, and let people make their own judgments about what the relationships mean or don’t mean.  If something’s wrong, then exposure will help to correct it.  Like Justice Brandeis said almost a century ago, ‘sunshine is the best disinfectant.’”

This applies to both physicians and politicians.  I hope we find that politicians are as ethical as physicians are.  If so, the public will be well served.

Read Full Post »

Lowering the Cost of Health Care

On Getting Better Health Care, physician Cynthia Koelker, M.D., describes practical ways people can lower their health care costs right now.

Koelker is author of the book 101 Ways to Save Money on Health Care.

We don’t need government to legislate health care reform to lower costs if we take some personal responsibility. Click here to listen to the show.

Read Full Post »

Do doctors really over-test because of malpractice risk?

An article from June in the Archives of Internal Medicine —  “Physicians’ Views on Defensive Medicine: A National Survey (Tara F. Bishop, MD; Alex D. Federman, MD, MPH; Salomeh Keyhani, MD, MPH)  —  said  doctors report that they over-test because of fears of malpractice.  I find this hard to believe.  If doctors really thought a test didn’t have any possibility of showing a problem, how could malpractice result from not doing the test?

We don’t do MRIs or CTs on our dermatology patients.  Those tests may get ordered in the ER because there is the possibility — albeit perhaps remote —that something serious is going on in the head.

I think what doctors are saying is that they do tests that are highly unlikely to be of value to make sure they don’t get sued for missing a highly unlikely event.  But from the patient’s perspective, shouldn’t they be offered that test even if there is only a small, small chance that a problem will be detected?  Unless the test is more dangerous than what might be found, offering the patient the test may be good medicine, not malpractice avoidance.

Read Full Post »

Insurers Reap Profits

Tribune Washington reporter Noam Levey reported that “the five largest health insurance companies racked up combined profits of $12.2 billion” in 2009 (http://seattletimes.nwsource.com/html/nationworld/2011050573_healthprofits12.html).

I’m sure there are many ways to spin this, but I’m not at all impressed that this is the cause of the high cost of health care. When the nation spends hundreds of billions, $12 billion in profit isn’t that striking. The article reported that profit margins for these large health insurers ran from roughly 3 percent to 7 percent, the higher numbers in part due to sale of part of the company. Growth in the stock market could have contributed as well.

We need to fix our health care system, no doubt about it. Demonizing one sector — like health insurers — is not the answer. Someone has to take responsibility for controlling costs. Right now, our third party payment system has taken much of that responsibility off of patients. That leaves high costs or rationing as the other options, neither of which is particularly palatable.

Read Full Post »