Category Archives: healthcare reform

I’ve long been an advocate for price transparency in healthcare. The Centers for Medicare and Medicaid Services (aka CMS) has recently taken action that requires hospitals to post their prices online, which should boost competition and help you shop around to save money. If memory serves, the price posting only applies to a limited number of services. I presume the rare hospitals that don’t accept Medicare and Medicaid payments are exempt.

From MedPage Today:

This week [June 2022], CMS handed down their first penalties to two hospitals in Georgia for failing to comply with the price transparency law that went into effect Jan. 1, 2021.

Northside Hospital Atlanta in Sandy Springs and Northside Hospital Cherokee in Canton were both fined for a lack of readily available standard charges for hospital services online, despite warnings.

The fines were on the order of $200,000 and $900,000.

If you find a hospital breaking the law, report ’em to CMS!

Steve Parker, M.D.

PS: Let me help you avoid hospitals.

In your ideal world, would you prefer your physician’s income reflect:

• number of patients seen and procedures performed, or
• high quality of care, reflected in ready accessibility, lowering cost without compromising care, compliance with science-based guidelines, and patient satisfaction/experience, or
• combination of the above

In other words, do you want your physician incentivized by volume or value?

It doesn’t matter what you want anyway, peon.

A recent study looked at salary arrangements for doctors in system-affiliated physician organizations in four states. The main conclusion:

The study results suggest that despite growth in value-based payment arrangements from payers, health systems currently incentivize physicians to maximize volume, thereby maximizing health system revenues.

This in-depth multimodal cross-sectional assessment of compensation and incentives among health system–affiliated POs [physician organizations] for which there is greater exposure to VBP [value-based payment] and APM [alternative payment model] arrangements compared with independent practices found that volume was the most common form of base compensation by a wide margin, being included by more than 80% and 90% of POs for PCPs [primary care physicians] and specialists, respectively, and representing more than two-thirds of compensation when included. Similarly, actions to increase volume were the most commonly cited means for physicians to increase their compensation. Base compensation incentives for physicians were not dominated by population or value-oriented payments, with only a third of POs reporting inclusion of capitation with PCPs and averaging only about a third of total compensation when included. Performance-based financial incentives for value-oriented goals, such as clinical quality, cost, patient experience, and access, were commonly included in compensation but represented a small fraction of total compensation for PCPs and specialists in health systems, operating at the margins to affect physician behavior. Taken together, these findings suggest that despite growth in APMs and VBP arrangements, these value-based incentives were not commonly translated into health system physician compensation, which was dominated by volume-oriented incentives.

The problem is that it’s a lot easier to measure volume than value. Easy wins.

Steve Parker, M.D.

Ref: Physician Compensation Arrangements and Financial Performance Incentives in US Health Systems in JAMA Network

PS: Avoid the medical-industrial complex as much as is safely possible. Let me help.

From an article published March 5, 2020, at The Hill:

March 2020 marks the 10th anniversary of the passage of the Affordable Care Act, also known as ObamaCare. In its first decade, ObamaCare has failed to solve many of the health care problems it was supposed to address. Even worse, it has compounded many of the issues it was meant to fix — the law of unintended consequences in action.

First, then-candidate Barack Obama said his namesake act would “cut the cost of a typical family’s premiums by up to $2,500 a year.”

In reality, the opposite has occurred. According to the Department of Health and Human Services (HHS), “premiums have doubled for individual health insurance plans since 2013, the year before many of Obamacare’s regulations and mandates took effect.”

***

Third, President Obama repeatedly assured voters, “If you like your health care plan, you’ll be able to keep your health care plan, period.” After ObamaCare was enacted, millions of Americans were unable to keep their pre-ObamaCare health insurance plan.

Individual market premiums were $2789/year in 2013, compared to $5712/year in 2017.

Obamacare proponents promised that the plan would drastically reduce the number of uninsured folks. Wasn’t it 30 million uninsured? But there are still 28 million uninsured. And it’s probably going to get worse since citizens are no longer forced to buy something they don’t want or can’t afford.

The author of the article is affiliated with The Heartland Institute.

Source: ObamaCare: 10 years of distress and disappointment | TheHill

Steve Parker, M.D.

PS: Avoid the medical-industrial complex by getting and staying as healthy as possible. Let me help.

From UPI Jan. 31, 2020:

Despite spending far more on health care than other wealthy nations, the United States has the lowest life expectancy and the highest suicide rate, new research shows.

For the study, researchers at The Commonwealth Fund compared the United States with 10 other high-income nations in the Organization for Economic Cooperation and Development (OECD)—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom—and with the average for all 36 OECD nations.

In 2018, the United States spent almost 17 percent of its gross domestic product (GDP) on healthcare. That’s more than any other high-income country and twice the overall OECD average. For example, New Zealand and Australia spent 9 percent of GDP on healthcare.

U.S. healthcare spending now tops $10,000 per person, and much of it is driven by private insurance costs such as premiums, according to The Commonwealth Fund report published online Jan. 30.

Source: U.S. health stats remain low despite trillions in healthcare spending – UPI.com

The numbers above are outdated. U.S. health care spending grew 4.6 percent in 2018, reaching $3.6 trillion or $11,172 per person.  As a share of the nation’s Gross Domestic Product, health spending accounted for 17.7 percent.

Click to learn what that money is spent on.

Click to learn why U.S. healthcare is so expensive.

Steve Parker, M.D.

PS: Why not try to avoid healthcare spending by getting and staying as healthy as possible? Let me help now. And for less than $20.

 

The U.S. has a presidential and other federal elections later this year. So we’ll be hearing more talk about healthcare reform. Mostly talk, not much action. Healthcare is an issue because it soaks up 18% of GDP (Gross Domestic Product). Many of us think that’s way too much and we can’t afford it anymore. Most other fully developed Western nations spend 9–11% of GDP on healthcare. Are we in the U.S. getting our money’s worth? Probably not, if you look at things like longevity, infant mortality rates, and overall disease burden.

When I aim to cure a disease, it helps immensely if I know the cause of the disease. That determines the treatment plan. If we want to fix over-spending on healthcare, we need to know the causes. With the right treatment plan, we might get healthcare costs down to 5% of GDP.

On the other hand, perhaps we in the U.S. love spending 18% of GDP on healthcare. It provides a lot of jobs. I personally make a very nice living with it. Nowhere near the $7.7 million/year of the average NBA player or $2.7 million/year for the average NFL player. At least I know I’m saving lives and alleviating suffering.

Here are the causes of overly-expensive healthcare:

• Lack of price transparency
• Third-party payer between patient and provider (they must be paid). Third party may not care about cost; just pass it on via premiums, or insulate themselves via high deductibles.
• Defensive Medicine: excessive testing and consultations, malpractice insurance premiums, time away from patient care
• Excessive regulation
• Government essentially mandates Emergency Department care regardless of ability to pay
• Excessive administrative costs (bureaucracy) of a byzantine system: providers’ office, healthcare insurance, hospital administration, regulators
• Lobbying protects insurers, doctors, hospitals, Big Pharma at the expense of consumers
• Low or no deductibles (no skin in the game)
• Little incentive for patient to get or stay healthy
• Government and insurers pay lousy docs the same fee as good doctors, so no incentive for great care or innovation. If you want to improve healthcare, you must financially reward competent and successful competitors. 
• Providers are incentivized to provide services: provide more services, earn more pay
• Greed
• Insurance mandates
• Government price controls (Medicare and Medicaid)
• Inadequate competition among providers
• Un-enforced anti-trust and consumer protection laws 
• Excessive drug costs
• Over-utilization of specialist care instead of primary care
• Laws prevent importation of drugs by patients or providers from cheaper markets
• Insurance companies prohibited from selling across state lines?
• Pharmacy Benefits Management Co’s
• Insurance pays for too much, instead of only catastrophic care?
• Waste and fraud?
• Monopolies or near-monopolies (e.g., dominant hospital systems, insurance companies)?

If I’ve missed anything, please leave it in a comment below or email me at steveparkermd[at]gmail[dot]com.

Steve Parker, M.D.

PS: Below are some interesting links I found while researching this post.

From Investopedia in 2019:

“Even with all this money being spent on healthcare, the World Health Organization ranked the U.S. 37th in healthcare systems, and The Commonwealth Fund placed the U.S. last among the top 11 industrialized countries in overall healthcare.”

 From CNBC.com March 2018:

“The real difference between the American health care system and systems abroad is pricing.”

From JAMA Network March 2018:

“The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries.”

Yale Insights 2016 report focusing on hospitals:

“This study tells us that insurance premiums are so high because healthcare provider prices are incredibly high. The way to rein in the cost of healthcare services is by targeting the massive variation in providers’ prices. We can do that by making prices more transparent, making these markets more dynamic, and really blunting the monopoly power that a lot of large healthcare providers have, which has allowed them to raise prices.” Interviewee says the hospital industry is 8% of GDP.

PPS: Why not do everything you can to get and stay healthy, hopefully keeping you out of the Medical-Industrial Complex? If you need weight loss and exercise, I can help…

I don’t have the resources to confirm the figures below, but I won’t be surprised if accurate. From Public Interest on Twitter:

Monthly cost of:

Lantus (Insulin)
🇺🇸 $373
🇨🇦 $67
🇬🇧 $64
🇩🇪 $61
🇦🇹 $54
🇫🇷 $47
🇳🇴 $42

Januvia (Diabetes)
🇺🇸 $331
🇨🇦 $68
🇬🇧$48
🇩🇪 $39
🇫🇷 $35
🇳🇴 $34
🇦🇹$34

Advair (Asthma)
🇺🇸 $310
🇨🇦 $74
🇬🇧 $47
🇩🇪 $38
🇫🇷 $35
🇦🇹$29
🇳🇴 $24

Is this what America first means?

— Public Citizen (@Public_Citizen) August 16, 2019

https://platform.twitter.com/widgets.js

Lower carb eating is likely to reduce the need for diabetes drugs.

Steve Parker, M.D.

Don’t count on nurse Aesop. I’m sure he’s not alone. Few healthcare providers got into the business to put their lives on the line every day. The Ebola virus is highly contagious and often lethal. Prevention of the spread of Ebola to healthcare providers and the general population requires high-level isolation units. Aesop says there are only 15 such beds in the U.S. (He calls them BL-IV beds). There are zero at most hospitals and zero in most cities.

What follows are Aesop’s words:

We aren’t set up for this [virus], and we’re doing nothing to stop it getting here (rather the opposite in fact).

And when it does, after those first 15 beds are occupied, we’ve done nothing anywhere close to adequate to handle things properly and nip it in the bud.

But everyone in charge pretends we’ve done exactly that, when nothing could be further from the truth.

Maybe you can bullshit the Low Information Viewers in flyover country, but you can’t bullshit me or countless other doctors, nurses, and ancillary staff who’ll be on the frontlines (for about 20 seconds, in my case) before we drop our clipboards where we’re standing, and head for the parking lot.

I may make a bullshit excuse about not feeling well, I may pass off report on my patients to someone else who stays, but go I will, and I mean within minutes.

I can’t collect paychecks at Forest Lawn [cemetery], and I won’t be helping anyone shitting my intestines into my scrub pants, and both of those are slam-dunk outcomes with the present (and perpetual) half-assed level of preparedness for Ebola or any one of 27 other pandemic-worthy infections at every hospital (but for a small part of a bare few) from Anchorage to Miami, and Maine to Hawaii.

Anyone wants to go to medical or nursing school, and go work on the frontlines of Ebola with WHO or the CDC, rolling the dice you’ll live to retirement every time you scrub in or out, operators are standing by. (When every hospital has an actual 24/7 BL-IV capability, and staffs and supplies and trains for its use regularly – by which I mean more than once a year or three to salve their own charred consciences and pen-whip JCAHO’s lackadaisical clipboard commandos – we can talk. Otherwise: F**K that noise. Sideways, with a rusty chainsaw.)

In such an epidemic, there is no such thing as a valiant death.There’s just death.

I’ll do my damnedest to save your life if you come into my ER.

But I won’t kill myself to do it, and I won’t die for you because TPTB [the powers that be] at every level are too half-assed and cheapskate to prepare for this as if it was Really A Thing, too stupid to know that, and too evil to care. That ain’t in my contract, and unlike joining the Marines, I took no such oath, and it isn’t part of the deal.

I don’t know how many out of 4,000,000 medical practitioners will be that honest and tell you that up front.

I just did.

Source: Raconteur Report: Where The Problem Is

Have a great day! 🙂

Steve Parker, M.D.

Most of the numbers below won’t mean much to you because they are mind-boggling. Also note that most of the cost is caused by type 2 diabetes in people over 65. From Diabetes Care:

“The total estimated cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity. For the cost categories analyzed, care for people with diagnosed diabetes accounts for 1 in 4 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes. People with diagnosed diabetes incur average medical expenditures of ∼$16,750 per year, of which ∼$9,600 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures ∼2.3 times higher than what expenditures would be in the absence of diabetes. Indirect costs include increased absenteeism ($3.3 billion) and reduced productivity while at work ($26.9 billion) for the employed population, reduced productivity for those not in the labor force ($2.3 billion), inability to work because of disease-related disability ($37.5 billion), and lost productivity due to 277,000 premature deaths attributed to diabetes ($19.9 billion).”

Source: Economic Costs of Diabetes in the U.S. in 2017 | Diabetes Care

Drastically reduce your diabetes healthcare expenditures by incorporating the ideas in my books. The ball’s in your court.

Steve Parker, M.D.