Orthopedist vs. Anesthesia and a Pair of Articles Putting the ACA in Historical Perspective

Extranormal produces great 'homemade' videos.  Some of the pronunciation of medical terms is rough (asystole = the heart has stopped for my nonmedical readers. Temperature of 29= 84 degrees F, and normal pH is 7.4)

By the way, a nicely paired set of articles by perceptive NY Times journalists today and tomorrow.

Today, David Leonhardt reminds us that this quote

“We are against forcing all citizens, regardless of need, into a compulsory government program,” said one prominent critic of the new health care law. It is socialized medicine, he argued. If it stands, he said, “one of these days, you and I are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.”


is from Ronald Reagan talking about Medicare in the 1960s.   He goes on to discuss the tension between Americans who believe in individual responsibility (the laissez fair conservatives) and those who believe in a minimum standard of living (progressives.)  Both traditions have played a role in America's success; the tension remains


Tomorrow, Matt Bai reminds us that Social Security started collecting premiums in 1935 but didn't pay out pensions until 1941 - and was under siege for decades until it became a critical part of our social fabric (and until most families were getting some benefit from the program).  He suggests that the final analysis of the Affordable Care Act can't be written for a generation. 

URL Dump

So many good articles, and so little time to blog about them.

A few articles worth bookmarking:

12/11/10 Associated Press reports on efforts in Massachusetts to lower costs

12/10/10 WBUR reports on a large delivery system joining a Blue Cross Blue Shield global payment system  

12/12/10: NYT business section article pointing out that physicians right now offer less access to those in low-reimbursement health plans such as Medicaid.   We're rationing care - just not explicitly

12/13/10: New Yorker article ‘The Truth Wears Off’ explains why clinical trials initially report huge impact, and that impact is much lower in the real world.  This article is behind a paywall, and I will be writing a blog about implications of this article later this week. 

12/12/10: New York Times editorial on the deficit and health care 

12/12/10: New York Times report on spouses getting Medicaid coverage even though they have the means to pay for nursing home care 

Urologists Recommend IMRT for Prostate Cancer – And Double Their Income

Today’s Managing Health Care Costs Indicator is $40,000

The Wall Street Journal continues to review Medicare payment records and ask probing questions about where the money is going.  I’ve previously recommended the WSJ evaluation of some of the high-billing probably fraudulent metro New York primary care physicians

Last week, the WSJ turned its attention to intensity-modulated radiation therapy  (IMRT), which is used to treat prostate cancer.  Among the treatments for prostate cancer are watchful waiting (small cost), surgery ($16,000 by the WSJ – sounds low to me), radiation seed implant ($19,000), and IMRT ($40,000). IMRT uses a computer to do a 3-D reconstruction to limit the amount of radiation delivered to noncancerous tissue.

The WSJ posts estimates from vendor about how IMRT can boost the income of a urologist by $336,000 if s/he refers just two new cases a month.  IMRT became available in the mid-2000s, when the urologists were suffering from serious loss of income after Medicare clamped down on profiting from prostate cancer drug markups.

Self referral continues to drive health care costs higher.  I’ve blogged on this before – there are higher rates of rotator cuff surgery in the practices of surgeons  who own ambulatory surgery facilities, and orthopedists who own MRIs and CTs refer to their machines with apparently excessive frequency.   Here’s a link to an older review of the literature on self referral.      

I don’t think many urologists who give IMRT believe that they are overutilizing this procedure.   However, the potential to double income is highly likely to have a subconscious effect.   We need to get away from paying for each unit of service, and dangling almost irresistible incentives in front of those who we expect to make decisions in the best interests of their patients.

Medical Bills Lead to Refinancing Woes

Today’s Managing Health Care Costs Equation is $11+$11=$14,000

There have been many reports of medical bills contributing to personal bankruptcies in the United States.   In 2007 researchers suggested that medical problems were associated with 62% of personal bankruptcies (and almost four in five of those who had medical cost-associated bankruptcy had health insurance).   

The Wall Street Journal reported this week that small unresolved health care bills were taking a bite out of credit scores from some unaware consumers – leaving them unable to get inexpensive refinancing.    Consumers could pay decades of higher interest because they were turned over to collection agencies for tiny bills.   One Texas resident reported that refinancing would carry $14,000 in fees since she had two $11 physician charges which had been turned over to a collection agency.

Thanks to John Donahue for this suggestion.