Hospital Crisis and Obamacare

[Pam]

swampy wrote:
Pam, Politifact it all you want, but I think the number does reflect a majority of doctor's feelings about Obamatax.

I have seen a great many doctors and medical practicioners over the past three years and have discussed current trends in health care. _None_ that I talked with liked the future they saw coming. Not a one! Most agreed that costs would rise, care would be rationed in some degree and overall patient care will decline due to lack of doctors. Tort reform was a major concern for them financially.

Their other big concern was the USPSTF. It was my oncologist who pointed out that the the U.S. Preventive Services Task Force, that recommended mammograms for women under 50 were not beneficial, did not have a single clinical oncologist or breast surgeon on the panel. Her fear is that this panel will be the determiner of patient care and health decisions will be bast on cost effectiveness.

Costs are already going up and have been for a long time. Care has been rationed much longer via financial limitations of patients and health insurance companies denying or restricting treatment overriding doctor decisions. Tort reform is one of those portions of Obamacare that could be addressed if both parties sit down to do their jobs and stop pandering to bases or who lines their pockets.

I applaud the USPSTF's recommendations on mammograms. They had the balls to fight the groups that are pushing for more. Not because it helps women, but because it makes money! Talk to radiologists! The money made on these machines, on the unnecessary biopsies that result, on the groups fundraising for breast cancer, and you should be sick. Women have been sold a huge ball of crap and gratefully shell out the money, and pooh pooh the stress because they were told it was benign. The numbers are huge. The amount of money is even larger. People always revert to, well if it saves a life, but that's not the case. Which is why the guidelines were changed. You find a lump, you get checked out. You have family history, you start earlier. Otherwise you follow the guidelines. I truly, sorely wish all of that well intentioned, donated money went to research to determine the cause of breast cancer and identify which cancers are worrisome and which are not. Not spend the money lining pockets and putting women through the wringer.

1.6 million biopsies are done each year. 90% are benign. That means 1.44 million women were subjected to cost, pain, and stress. That number should be far, far lower. It should invoke outrage just as similar numbers did for prostate cancer. But that cancer involves men and is not a sexy money maker. They tried.

[mattkime]

wowzer, how do you really feel?

[rgG]

Pam wrote:

Costs are already going up and have been for a long time. Care has been rationed much longer via financial limitations of patients and health insurance companies denying or restricting treatment overriding doctor decisions. Tort reform is one of those portions of Obamacare that could be addressed if both parties sit down to do their jobs and stop pandering to bases or who lines their pockets.

I applaud the USPSTF's recommendations on mammograms. They had the balls to fight the groups that are pushing for more. Not because it helps women, but because it makes money! Talk to radiologists! The money made on these machines, on the unnecessary biopsies that result, on the groups fundraising for breast cancer, and you should be sick. Women have been sold a huge ball of crap and gratefully shell out the money, and pooh pooh the stress because they were told it was benign. The numbers are huge. The amount of money is even larger. People always revert to, well if it saves a life, but that's not the case. Which is why the guidelines were changed. You find a lump, you get checked out. You have family history, you start earlier. Otherwise you follow the guidelines. I truly, sorely wish all of that well intentioned, donated money went to research to determine the cause of breast cancer and identify which cancers are worrisome and which are not. Not spend the money lining pockets and putting women through the wringer.

1.6 million biopsies are done each year. 90% are benign. That means 1.44 million women were subjected to cost, pain, and stress. That number should be far, far lower. It should invoke outrage just as similar numbers did for prostate cancer. But that cancer involves men and is not a sexy money maker. They tried.

I agree. Could not agree more.

Also, we have to realize that good medicine is not treating every illness with the latest and most expensive high tech machines and drugs when often an older, more proven, and cheaper alternative exists. But the drug companies sell doctors on the latest and the greatest, and many doctors don't even consider the cost, they just figure that insurance will cover it, like it is a free lunch. And the drug makers advertise all the latest drugs directly to the consumer and tell you to ask your doctor about prescribing them for you.

There is way too much overhead in medicine. You should not have to have a staff of people just to code bills, how insane. It is this overhead, coupled with high malpractice insurance, the subsequent overuse of expensive testing and procedures to cover the doctor's liability, that have driven up the cost of health care.

The current health care bill needs work, a lot of work, but to just leave things as they are is not an answer. As has been said, the politicians, doctors, insurance companies, drug companies, and the states need to work this out. It can be fixed, but everyone is going to have to give a little.

[wowzer]

lafinfil wrote:
No offense to you personally, because I am sure that you are a good doctor. As I see it one major problem with the malpractice "crisis" is the refusal over the years for the medical profession to police itself and rid itself of the bad actors instead of looking the other way (primarily state medical licensing) Get rid of the revolving door of drug addicted anesthesiologist, the sloppy surgeons, etc... would be a start. Letting them walk away to go practice in a different state may solve a local problem but not a systemic one. In all your years have you ever questioned the actions of a peer? If so did you speak up ?

I was an observer from within for 15 years and an observer / advocate from the patient side for more than that (still am) If my mother or uncle is in need of care, I work my list of old contacts and ask for "non-recommendations". Who should we avoid, and then who should we see. Docs I know were complaining about the same (malpractice) over 30 years ago so this is nothing new IMHO - just a new convenient target. It's one of those "heal thy self" things but the overseers of the profession don't seem willing.

First off, the so called, 'bad' doctors (i.e. those with many malpractice losses) are frequently taking care of high risk patients. It is ONLY the plaintiff attorneys who label these doctors as, 'bad'. I sit on my hospital's peer review board--and yes, mistakes happen--but there are almost always extenuating circumstances. Very rarely do I find a doctor who has done something truly egregious, but to answer your question, yes, I've fired those extremely rare 'bad' physicians (only 1 or 2 over a 15 year experience in administration). It's far trickier than you imagine, as there are always grievance meetings and due rights from human resources. Also, hospitals are not allowed to arbitrarily deny privileges to doctors--unless there are specific and substantiated reasons, if a physician presents the appropriate credentials and meets the standards, the hospital is obligated to grant privileges. (BTW- these rules and regulations were created by other lawyers who make the cost of doing business more expensive.)


To address the issue of legitimacy of malpractice suits, if I recall correctly (I'll try to find the reference), Harvard law school's study many years ago demonstrated that only one third of all malpractice settlements and judgements were in fact as a result of malpractice. Furthermore, of the cases of legitimate malpractice, only 40% of the patients actually ever sued. The data was based upon closed cases and peer reviewed data, and the Harvard Law team had the Harvard Medical team review the medical cases. When that study was released, it quickly became apparent to me that lawsuits mean nothing about the quality of the physician. Nothing.


What the Harvard study meant to me was that lawyers are far worse at screening out 'bad' lawsuits. If there is a profession which needs to be brought under control, it is law and judisprudence. I think that the entire law profession should be required to do a top down review of their practices and policies to ensure that only legitimate cases are brought to trial.

[wowzer]

Pam wrote:
[quote=wowzer]
[quote=Pam]
Hate to tell you, but it's already happened. Tossing Obamacare won't change the path we're already on.

True, but at least it wont bring down the rest of America. The only places where this was happening was the heavily democratic states (NY, MA, RI, CT, etc). That's because the democrats love trial lawyers and frivolous lawsuits. By creating an extension of medicaid, it will expand the trial lawyers' influence on the rest of America. This is going to get very, very ugly. I'm glad that I'm in mid-career...and wont have to feel the repercussions too much. I'm really concerned about our kids and the next generation.
Well no, it's happened in Virginia as well.

I don't and never have seen Obamacare as a rigid document. In my dream world, after the election, both sides can put their partisanship aside and iron out some kinks. It's fine if it's in back rooms and they snipe in front of the cameras. As long as it's done.

I would vote for that! But you and I both know that the world has become very unforgiving and very unwilling to bend. The truth is that obamacare was forced down the throats of the republicans. You can bet that they will fight it. I bet some democratic governors will not enact the medicaid expansion, as long term projections show billions of losses to the state when the federal government pulls out financial support. Simply put, the math just doesn't work out.

[Lemon Drop]

I appreciate the beautiful, state of the art, constantly renovated hospitals in my state. I notice those other places when I travel around the country. It couldn't be that we have too many high price hospital beds in some areas and can't fill them, could it? Just asking.

The only places where this was happening was the heavily democratic states (NY, MA, RI, CT, etc).

It's hard to take easily disproved partisan comments like that seriously. Continuing to treat this like a political problem instead of a serious national challenge isn't going to get us anywhere.

Here are the 10 states with the safest hospitals, meaning you are least likely to get killed in one of them, according to a recent national survey:
Mass, Maine, Vermont, Illinois, Tenn, VA, MI, CA, DE, MN.
What are those states doing right?
We know one has "Romneycare."
Let's look at the best and learn and copy that and continue to innovate, reform, and improve.
Time to quit the partisan whining in this issue.

[Pops]

wowzer wrote:

First off, the so called, 'bad' doctors (i.e. those with many malpractice losses) are frequently taking care of high risk patients. It is ONLY the plaintiff attorneys who label these doctors as, 'bad'.

From a layman's perspective, I have always believed this to be the case.

[wowzer]

michaelb wrote:
This thread makes no sense to me, what issue are we discussing?

The ACA has quality incentive payments built into to Medicare reimbursement? How is that a bad idea generally?

The ACA will dramatically reduce the number of uninsured going to hospitals for acute care. This is a major problem for hospitals everywhere. Having coverage for most everyone wil outweigh reimbursement rate issues (which actually aren't going down) by 10 to 1. The States that opt out of the Medicaid expansion are of course going to have major problems that they will be completely responsible for bringing on themselves. Their money will flow for once to the states that do expand so that will be a nice change of pace. The overwhelming pressure and obvious need will flip those states, it is just a matter of time (but yes, some of their hospitals may collapse due to the uninsured).

Malpractice lawsuits are not a major factor in overall health care spending. But States are free to adopt all the changes and restrictions they want. Malpractice is not a federal issue, that is left to the states. The States that have adopted malpractice reform haven't seen any meaningful cost reductions. But reasonable reform makes sense to me too.

I can't spend the time to fight point to point (I have data and evidence for each of them). Suffice to say that the 'quality' metrics have been reviewed by the doctors and overall we think that they wont help at all (search medscape 2012 survey).

States that opt out wont face the financial burdens under ACA. The Federal government would (i.e. taxpayers). This is the major concern--how in the world is ACA going to control costs when it has eluded generations of administrators and politicians? The simple answer is that costs will balloon and the individual taxpayer will get saddled with the bill.

As for malpractice--how can it be a state's issue? If insurers are multi-state (and many if not all attorney groups are inter-state), then it is definitely interstate commerce. In addition, since ACA has setup national benchmarks of quality and safety metrics for hospitals and doctors, thereby establishing a national standard of care, then all hospital based lawsuits should be Federal. I suspect some hospital/group/organization will try that argument very shortly.

[wowzer]

mattkime wrote:
wowzer, how do you really feel?

Just felt a little more concerned about the US of A and I had to vent (which I very rarely do as it is completely counter-productive)...

[Pam]

wowzer wrote:
[quote=Pam]
[quote=wowzer]
[quote=Pam]
Hate to tell you, but it's already happened. Tossing Obamacare won't change the path we're already on.

True, but at least it wont bring down the rest of America. The only places where this was happening was the heavily democratic states (NY, MA, RI, CT, etc). That's because the democrats love trial lawyers and frivolous lawsuits. By creating an extension of medicaid, it will expand the trial lawyers' influence on the rest of America. This is going to get very, very ugly. I'm glad that I'm in mid-career...and wont have to feel the repercussions too much. I'm really concerned about our kids and the next generation.
Well no, it's happened in Virginia as well.

I don't and never have seen Obamacare as a rigid document. In my dream world, after the election, both sides can put their partisanship aside and iron out some kinks. It's fine if it's in back rooms and they snipe in front of the cameras. As long as it's done.

I would vote for that! But you and I both know that the world has become very unforgiving and very unwilling to bend. The truth is that obamacare was forced down the throats of the republicans. You can bet that they will fight it. I bet some democratic governors will not enact the medicaid expansion, as long term projections show billions of losses to the state when the federal government pulls out financial support. Simply put, the math just doesn't work out.
Thing is Obamacare is for the most part, a Republican plan. They couldn't pass it and let Obama get a win. They had to act as though this plan was a product of liberal Democratic minds. As it is Obama had to make deals with pharma he didn't want to get it passed. As without them it would not have passed. So you have Republicans who want it gone simply to take away a Democratic victory, and you have pharma and as well as the insurance companies lining pockets to protect their profits. Just who is really looking out for the average American citizen?

Long term projections are guides. That's it. If congress cannot get their collective asses together and work on what's best for the country it won't matter if Obamacare stays in place.