This appeared in a Wall Street Journal editorial:
Beginning in 2015, Medicare would rank doctors against their peers based on how much they cost the program – and then automatically cut all payments by 5% to anyone who falls into the 90th percentile or above.
Since there will always be a missing chair when the music stops, every year one of 10 physicians will be punished if he orders too many tests, performs too many procedures or prescribes too many drugs – whether or not the treatments result in better patient outcomes. The 5% fine is substantial given that Medicare’s price controls already pay only 83 cents on the private dollar.
Hardest hit: cardiology and oncology.
The one abiding principle of the politics of medicine: Overprovide to the healthy and underprovide to the sick:
The most widely used treatment for stroke victims is a clot-busting drug called tissue plasminogen activater (tPA), but it must be administered within three hours of the first symptoms.
Problem: timing is critical, and an expert doctor must decide whether tPA is appropriate. But many hospitals do not have an expert.
Solution: telemedicine.
Obstacle: state laws that prohibit practicing across state lines and the Stark Amendments, which prevent financial arrangements between physicians and facilities. [link]
Heart doctors do what they get paid to do:
Coronary artery bypass surgery, angioplasty and the placement of drug-coated stents – cost about $60 billion a year in the United States. Though they are not known to prevent heart attacks or coronary mortality in most patients, they are covered by insurance. Counseling patients about diet, exercise and stress management – which is relatively inexpensive and has been proved to be life-extending – is rarely reimbursed.
However, what they don't get paid to do is often better for patients:
Putting stents in [relatively healthy] patients is no more protective than following a heart-healthy lifestyle and taking medication and, if necessary, nutritional supplements to reduce cardiac risk. The studies have also shown that stents sometimes make matters worse by increasing the chance that a dangerous clot will form in a coronary artery.
Here's the new theory:
Most heart attacks do not occur because an artery is closed by a large plaque. Rather, a relatively small, unstable plaque ruptures and attracts inflammatory cells and coagulating agents, leading to an artery-blocking clot.
In most Americans middle age and older, small plaques are ubiquitous in coronary arteries and there is no surgical way to treat them all.
Full piece is from Jane Brody.
Health Care Policy and Reform Insights | NCPA