Posts Tagged ‘economy’

President Obama’s 2011 State of the Union address was forward-looking. In the address, he mentioned the Internet six times, focusing much attention on American infrastructure, technology and our future economy.  The President said within the next five years, the next generation of high-speed wireless coverage will be deployed to 98 percent of all Americans.

At DrScore, we’re forward looking too.  Paper-based surveys of patient satisfaction are horse-and-buggy technology, expensive, time consuming and wasteful.  Online doctor rating has many advantages, including flexible, drill down survey methodology. As all Americans gain greater access and facility working online, the few barriers that remain to obtaining low cost, easy, high quality patient feedback through the Internet will quickly melt away.

DrScore is just one small facet of the future that President Obama shared with us: an economy that’s driven by new skills and new ideas.  Our success in this new and changing world will require reform, responsibility, and innovation.

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The monthly newsletter came from my medical specialty society.  There was an article on how much doctors are being paid, pointing out that in 2009 doctors in my specialty experienced an increase in average income of between 7-12 percent, though specialists in general saw a decrease of about 4 percent.

In a down economy with a lot of people hurting and roughly 10 percent unemployment, doctors have been relatively spared from financial pain. As the deficit commission looks into ways to cut costs, reducing payments to doctors will be considered.  I suspect physician organizations will aggressively fight such cuts, pointing out that potential cuts in Medicare would hurt patients.

I don’t want to see patients hurt, but the patriotic side of me says that we doctors shouldn’t be completely spared from the effects of a down economy that is causing our patients to suffer.

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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.

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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.

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We dermatologists are watching with, well, glee, as a new tax on tanning takes effect. It’s funny how perceptions are colored by context. Most doctors probably hate the idea of more taxes, but it seems fine when the tax is on someone else, particularly someone who we see doing harm to people’s health.

Knowing how addictive tanning is for some people and how strong current societal pressures are on young people for a tanned appearance, I doubt this tax is going to change long-term skin cancer rates. Perhaps the income the tax generates will offset some of the government/societal cost of skin cancer treatment.  In fairness though, perhaps we should tax all cosmetic services equally — whether it is tanning or cosmetic surgery.

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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.

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I wonder if progress toward rational health care reform could be made if Congress would get some momentum moving forward by passing legislation everyone could agree on. So, I have decided to make a suggestion.

Aspects of good health care include:

1) giving patients instructions in writing, and

2) sending patients the results of any tests performed — whether the test found a problem or not.

These measures help ensure that patients have the information they need to be involved and responsible in their own care. I believe that linking payment incentives for quality to these measures would quickly change the culture of our medical system, which all too often fails to address these simple actions.

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The impact of the partisan debate hit home when someone told me she came in for care because she was worried that Obama would soon take away her Medicare.  How ridiculous is that I thought!  She went on to talk about how the proposed health care reform legislation includes plans to kill old people.  I had trouble believing that anyone would really accept such partisan nonsense, but here it was.

We could go into detail, but let me just say those ideas are ridiculous.  I don’t think the Democratic plan to solve our health care crisis is the right one, but ending Medicare or plans to kill old people are not the problems with it.  One thing we should keep in mind is that those people promoting health care reform, both Democrats and Republicans, are simply trying to help Americans get better care without going broke doing it.

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A Jan. 5 New York Times article reported that health care spending grew in 2008 at the slowest pace in 48 years, only up 4.4 percent from the previous year (down from an average increase of 7 percent a year in the decade from 1998 to 2008). A Feb. 4 Washington Post article reported that health care spending in the United States grew by 1.1 percent in 2009 compared with 2008. While the slowing of health care costs growth may seem somewhat promising, it is shocking that health care expenses continued to increase despite the rest of the economy shrinking. Health care costs are gradually approaching 20 percent of the overall economy.

The idea that health care spending should take up 20 percent of the economy seems totally out of proportion and unsustainable (although one uncle of mine suggested that spending on health care may be money better spent than using that money for weapons). The costs continue to grow, while the number of uninsured continues to increase. The idea that government is going to take over health care is already here, at least in terms of paying for much of it.

The last presidential election and subsequent elections seem to have made clear that there needs to be an open consensus process on how to solve the problem. There is a growing minority of people who have poor access to care, and everyone agrees that the problem needs to be fixed. There is a shrinking majority who are paying heavily for access. Their costs continue to grow, and everyone agrees that that problem needs to be fixed, too.

The hard part is coming to a uniform consensus about what needs to be done. The solution will need to consider that there are no free lunches to fixing the problem. Patients can’t have unfettered access to any treatment at any price paid for by some third party — whether it is government or a private payer — if we’re going to reign in the cost of care. We’ll need to come to a consensus about which is the lesser evil: continued explosive growth in health care costs, rationing the health care options patients have, or making patients themselves more responsible for the costs of their health care decisions.

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