It just goes around and around and around

Seth sums it up rather nicely.

Patients are taught what to want by doctors who prescribe new tests. And doctors are taught to do that by lawyers eager to sue if they don’t. Imagine going home and saying, “the doctor wanted to give me another test, but I said no…”


So this means, from a health care perspective, we should not support “cap and trade?”  And that we should support ethanol subsidies?  As if health care didn’t have anything else to think about at the moment, Judith D. Schwartz writes that the industry’s dependence on oil should be a top concern:

One might not imagine oil and medicine would mix, but U.S. health care relies on cheap crude in multiple ways: from petroleum-derived pharmaceuticals (including such commonly prescribed drugs as aspirin, vitamin capsules, cortisone and many antibiotics, antihistamines, medicated skin creams and psychiatric medications), catheters and syringes to running and transporting high-tech machines and time-is-of-the-essence ambulance runs. This makes for great aseptic single-use equipment and complex, even heroic, surgeries, but it also leaves our medical system highly vulnerable to any disruptions to the oil supply — which experts say will undoubtedly happen, though no one knows exactly when.

Obesity is a problem and we don’t know what to do about it

What makes the obesity problem so difficult is that it pretty much came out of nowhere and we, in essence, have no reliable solutions to pursue.

The Wall Street Journal wrote last week:

The singular feature of American obesity is its steep, out-of-nowhere rise. For most of the 20th century, U.S. obesity rates were stable, with a slight upward trend through the late 1970s. Suddenly, they spiked across all demographic groups and have continued to rise unabated. In sheer body mass, the entire population is heavier than it used to be, and the heaviest are much heavier. Just between 1998 and 2006, obesity rates increased by 37%, according to the CDC.

The costs are nearly as startling. In a study published this week in the journal Health Affairs, CDC researchers estimate that obesity now accounts for 9.1% of all medical spending—$147 billion in 2008. The Milken Institute estimates that chronic disease costs more than $1.2 trillion every year. On top of the medical resources devoted to preventable illness, a fatter and sicker work force is a drag on economic growth. In effect, we’re eating money. (link to Health Affairs study)

Last week the CDC held its wittily named “Weight of the Nation” conference to discuss obesity in order to game plan its approach to fighting the problem.  What’s been tried/suggested (a few): discourage auto transit, eliminate agriculture subsidies, ban food advertising, interventions in the school, family, and community.  Read about them here in a piece by Megan McCardle; her summary of obesity-fighting efforts indicates most interventions up to (right) now have been rather unsuccessful:

But the political opposition these actions would face is absolute(ly) enormous. Americans were not blindly seduced into an auto-based lifestyle by the paver’s union; they voted for lots of roads because they like their cars. Every president since Reagan has wanted to eliminate farm subsidies, and every president since Reagan has thoroughly, utterly, entirely failed. Similarly, the food and entertainment industries are not going to stand idly by while you do away with 10% of advertising revenue. “Fix the schools” and “fix crime” are two agendas that society is currently aggressively pursuing, with limited success. And I’m skeptical that you’re going to find something north of $30 billion a year for the kind of early-child interventions that really seem to make a difference.

Addressing the obesity problem at the point of (health) care is too late.  It’s (mostly) a problem of individual choice and it seems the solution likely falls in the same hemisphere.  But that’s rhetoric, now onto the implementation…

Any ideas?

RELATED UPDATE: Guess we’ve been “shaving the bear…”

The P4P Conundrum

A WSJ article outlines the conundrum with pay for performance:

Can hospitals persuade discharged patients such as Betty Beauchaine to pass up a Fourth of July hot dog?

It’s more about the patients than the providers.  And if health status isn’t incentive enough, maybe greenbacks are.  From Marketplace:

We published a paper that shows that if you pay individuals $7 a pound, you can get the type of weight loss that’s traditionally seen through off-the-shelf weight- loss programs.

We will be what we eat

Have you seen Food, Inc? Not that we need another health care problem, but this one, at least on the surface, seems to be a potentially mighty one.  (Disclosure: my bias is high as my sister is a food scientist.)  This exchange about genetically modified, mass produced food and increased caloric consumption leading to a higher incidence of diabetes is interesting:

Robert Kenner: When I was a kid we spent something like 18% of our income on food, today we spend about 9%.

Jon Stewart: So we’ve won!

RK: That’s great.  The fact is we have really inexpensive food which is great news. The problem is now, when I was kid health care costs were about 5% of our paycheck and today they’re about 18%.  …  We’re not going to be able to fix the health care system until we fix the food system.

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Is pay for performance bunk? What does it really incent?

Remember pay for performance?  Incenting physicians based upon quality measures or patient outcomes or productivity?  A real good idea on the surface; also an idea proving difficult to implement.  Anyway, new research says pay for performance compensation packages in the general business world may not achieve its intended benefits.

Dr. Bernd Irlenbusch from the London School of Economics:

We find that financial incentives may indeed reduce intrinsic motivation and diminish ethical or other reasons for complying with workplace social norms such as fairness. As a consequence, the provision of incentives can result in a negative impact on overall performance.

Something to pay attention to in this era of reformation.

(pointer from Dan Pink)

Annnnnnnnd. You’re done.

Wowza.  Enough said:

A Dean Health System manager removed a nurse from a minor surgical procedure last week — in violation of medical protocol — in order to lay her off, a spokesman for the company confirmed Monday.

The abrupt removal, which spokesman Paul Pitas said posed no danger to the patient, came after the Madison-based health care provider announced Wednesday that it planned to “immediately” lay off 90 employees.

Pitas, director of corporate communications, labeled the action “clearly … an error in judgment on the part of the manager conducting the layoff.” He declined to name the manager but described her as “an otherwise good employe with more than 30 years of nursing experience who made a regrettable decision.”

Via HLM.

Health care’s problems encapsulated

The St. Louis Post-Dispatch reports on several health care meets the internet stories, the first about a cardiology group where “cardiology patients can hop online to request prescription refills, check portions of their medical records or send questions about their conditions.”

Great, but get this:

Within a few years, the interventional cardiologist expects to be trading e-mails with patients and possibly holding real-time Web chats.

Within a few years?  Four words (“within a few years”) sum up health care’s issues.  The pace of change in health care is infuriating (speaking of years)…

On the positive side, much of the article is about American Well—especially their deal in Hawaii; also included is apt skepticism provided by old grumps.

An internet infusion at Mercy Medical Group provides a bit of traditional health care delivery hope:

The patients will be able see lab results, get information about X-rays and schedule appointments through an interactive calendar.

Patients can take a picture of a suspicious rash and send the image in an e-mail. Doctors can respond to an e-mail question about high cholesterol with links to health-related websites.

Surliness ceased…for now.

The big engine that goes and goes

No doubt you’ve read about health care job cuts or freezes since the beginning of December.

Even the traditionally sound health care state of Minnesota (where modesty comes standard and unnecessary elective procedures are seen as just that) has announced trouble.

One could be forgiven for thinking that the nationwide number of health-related jobs has been decreasing along with the rest of the economy’s sectors. But it hasn’t. In fact, health care added 34,000 jobs in November as the nation’s economy shed a whopping 533,000. At a job fair last week in Galveston, Tex., health care professionals were being hired on the spot. Merrill Goozner writes on the job boom that has been health care:

The bottom line is that there are no signs yet that this downturn is affecting health care, which has been on a tear for decades. Since the trough of the last recession, home health care has added 343,000 jobs, making it the fastest growing field (up 54 percent). Outpatient facilities and diagnostic labs added a combined 202,000 jobs in this decade, a 37 percent hike. Firms that provide social assistance added a whopping 644,000 jobs, a 34 percent increase.

Doctors and dental offices in this decade added more than 622,000 jobs, but that was slightly less (24 percent) than the sector as a whole (26 percent). Hospitals and nursing homes were relatively slow growers by comparison, adding “only” 700,000 jobs (17.5 percent) and 373,000 jobs (14.2 percent), respectively.

Astounding. It’s too bad our economy can’t completely specialize in health care production. We seem to be pretty good at it when considered from a growth perspective. The problem is that unfettered growth used to be the end-all be-all; now we’ve entered a reality concentrated on value propositions and sustainability.

The job growth is good news, it really is. Something inside the economic engine needs to keep us going.

But we need to proceed carefully (walk softly and carry a big stick?). It will not continue in perpetuity. Disagree? Google News search: home values.  It’s not pessimism, it’s realism.

Health care is both adding and losing jobs.  What gives?  We’re late to the recession party. And as hard as Cinderella wishes off the midnight hour, time keeps ticking. The recession will negatively effect accounts receivable on three levels:

  1. Those individuals who are able to decide whether or not to become a patient are more likely to say no in the midst of a recession.
  2. 2008’s two million job losses means those former workers are losing insurance coverage.
  3. As dollars tighten at home, patients become less likely to pay their share of the medical bill.

It’s already begun.