Health care panel chief seeks solutions

As lawmakers started grappling yesterday with Governor Deval Patrick’s proposal to change the way hospitals and physicians are paid, the House point person on the cost control legislation offered advice to industry leaders at the first of five planned public hearings. Representative Steven M. Walsh, House chairman of the joint Committee on Health Care Financing, said he appreciated their criticisms of the bill but that their concerns did not constitute “a reason to do nothing.’’ “The next step is to point out some solutions,’’ said Walsh, a Democrat from Lynn. “We are going to do something, and we want you to be our partners.’’

“Or else”. Well, he didn’t say that, but that’s what he meant. The problem in MA is that the health care bill popularly known as “Romneycare” is costing the state way more than it was projected to back when it was passed. Remember that when people tell you how Obamacare was patterned after this law.

His [Patrick's]plan would begin to push health care providers into systems that pay for what Patrick called “whole patient care.’’ In such plans, doctors would be given a fixed payment for providing all care to each patient, instead of being paid for each diagnostic test or treatment service. The new design is meant to reward doctors for keeping their patients well. The governor’s bill would move state employees, Medicaid patients, and others with state-subsidized insurance into this system.

The people at The Globe either have poor memories, didn’t research thoroughly, or are hoping that the readers have short memories. This is not new in any sense of the word. It was tried back during the 1990s, and for all I know is still being used in some places. Back then the term was capitated cost back then. It was derided by many of the same Progressives who are infatuated with it back then because at it’s worst it gives physicians and hospitals an incentive to limit health care in the interest of saving money. There is another term for this; Rationing. Even if that is not in the bill, not specified, not advertised, de facto rationing will occur.

Anyone want to bet on how long it takes for the advocates for Medicaid recipients to file a law suit to exempt them, but not anyone else, from the provisions of this bill? Or how the trade off will be that everyone else will be forced into this type of system no matter where they get their health care or insurance?

Some in the industry cautioned lawmakers not to impede progress being made by some hospitals and insurers who, on their own, are changing the way they pay for care. Patrick said the law is necessary to broaden those efforts.

Just what we need. Elected busybodies who have never had to make a business run profitably or work within a budget telling those who have to manage budgets and can’t just jack up taxes when they fail how to run their businesses.

There have been plenty of other viable suggestions that have been ignored because they challenge too many special interest groups. Tort reform, implementing co-pays and deductibles for Medicaid patients, interstate competition for health insurance, to name a few. Not that we’ll see any of those in the near future.

Well, look on the bright side. If nothing else Romneycare will be a national model on how not to fix health care finance problems.

On a related note there’s this,

Fewer Emergency Rooms Available as Need Rises

 

Hospital emergency rooms, particularly those serving the urban poor, are closing at an alarming rate even as emergency visits are rising, according to a report published on Tuesday.

This trend also has been going on since the mid 1990s. Smaller hospitals found it economically unfeasible to keep their Emergency Departments open. So, they either closed them and became specialty hospitals, merged with larger hospitals and shifted their EDs to them, or in many cases just closed altogether and shifted their patient populations to larger hospitals.

Conditions in emergency rooms may be worsened by the new health care law, several experts said. The law will expand eligibility for Medicaid, the government health plan for the poor. Often beneficiaries turn to emergency rooms for care, because many physicians do not accept Medicaid payments, said Dr. Sandra M. Schneider, president of the American College of Emergency Physicians.

Remember those nostalgic days when Obamacare was supposed to cut costs, improve coverage, reduce waiting times in EDs?

But wait, there’s a solution at hand,

“This suggests market forces play a larger role in the distribution and availability of care” in the United States, Dr. Hsia said, especially emergency care. “We can’t expect the market to allocate critical resources like these in an equitable way.

So I guess that the government is supposed to ensure “equitability” in Emergency Department allocation. No doubt that will require hospitals to open EDs in areas where they can’t make any money and siphon money from areas where they can make money to support poor market choices.

As Ronald Reagan said, The most terrifying words in the English language are: I’m from the government and I’m here to help.

I read this post at the blog “Carpe Diem” with some interest. MinuteClinic Goes Viral, It Plans to Double the Number of Its Retail Clinics Over the Next 5 Years talks about the coming rapid expansion of in store clinics that see patients for urgent, but relatively minor medical complaints. They don’t replace primary care physicians, or at least should not. Nor should they replace emergency departments for emergency situations. They might be adequate for minor medical problems when you can’t wait for an appointment with your primary care physician (you really should have one) and don’t think your problem is severe enough for an emergency department.

Read the post and the comments following it because they show different perspectives.

I went to one of the clinics last year when I couldn’t get in touch with my primary care physician due to a phone screw up (mine). I felt miserable and was 99% sure that I had Strep Throat. If you’ve ever had that, you know how rotten it is, even though it is not life threatening. Mrs. TOTWTYTR drove me over to the nearby Minute Clinic and after a not very long wait I was ushered in to see the Nurse Practitioner. After getting demographic and insurance information, she started to ask me about my complaint. My first observation was that she was working from a computer driven algorithm, asking me question after question and entering the answers into the computer. She could not vary from the computer program and asked me a number of annoyingly irrelevant questions. Now, I’m sure that some of the questions I ask patients seem annoyingly irrelevant to them, but I have the latitude to skip questions if they don’t apply. The NPs at Minute Clinics don’t have that latitude. Also, and this might or might not be all that important, none of the NPs that I saw at the Minute Clinic appeared to have English as their first language. Take that for what it’s worth, but in theory at least it could pose communication problems.

After following her algorithm to it’s end, she decided that I might have Strep Throat. So, she took a throat swab that was supposed to quickly tell if that’s what I had. Traditional Strep tests take about 24 hours to be completed. The quick ones take about ten minutes to get a reading. The only problem is that the ten minute tests don’t seem to be all that accurate. At least in my case it wasn’t. The NP told me that I didn’t have Strep Throat and prescribed some sort of mouth wash and throat lozenges. I asked for a prescription for an anti biotic, but her protocol allowed for no variation and there was no mechanism for her to call a doctor is something seemed out of the usual. Which is an option I and most, if not all paramedics,  have. So, I went back home with my useless mouth wash and throat lozenges to suffer some more. The next day I got a follow up call and amazingly, the 24 hour culture showed that I did in fact have Strep Throat. So, back to CVS for a prescription for … anti biotics.

While Minute Clinics and other free standing urgent care operations will no doubt have a place in the future of medicine, potential patients should understand that they ARE NOT a replacement for having a primary care physician with which you can establish a relationship. As one of the commenters points out at “Carpe Diem” there are benefits beyond the obvious to having a primary care physician.

Half the folks we docs see have chronic problems, and often social ones, and having a primary care physician or equivalent is important for these folks.

It’s important for most patients, at least in my experience. There are also huge benefits in terms of continuity of care and referrals to specialists for more complex problems. You’re not going to get that from a Minute Clinic. In fact, you aren’t going to get a doctor at all. Which is the biggest flaw in this model of health care delivery.

I can’t even tell you if this is less expensive than seeing a doctor since my insurance covered the visit. I still had to pay the same co pay as if I had seen my primary care physician, so it wasn’t less expensive for me.

Overall, I don’t think I’ll be heading back to the Minute Clinic in the very near future, but from the numbers it seems like a lot of others are.