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"Paying doctors for results rather than procedures ..."

Just exactly what on earth does that mean?

From The Washington Post, whose article describes President Obama's new plan to lower our Federal budget deficit through tax increases and (snort) "spending cuts":

Administration officials and outside experts say the most likely path to revamping the health system is to begin with Medicare, the federal program for retirees and people with disabilities, and Medicaid, which serves the poor. Together, the two programs cover about 100 million people at a cost of $561 billion in 2007. Making policy changes in those programs -- such as rewarding physicians who computerize their medical records or paying doctors for results rather than procedures--could improve care while generating long-term savings, expert say. It also could prod private insurers to follow suit.

I don't really have the time or the desire right now to analyze the whole piece. Anyway, an analysis pretty much writes itself, if you simply ask a few good questions:

  • How are we going to cut the cost of Iraq and Afghanistan if we just committed another 17,000 troops to Afghanistan?
  • What else besides the Defense budget (one of the few large mandatory items in the Federal budget, in case you didn't know) will be cut? And by how much?
  • Just exactly whose tax rates will go up in 2011?
  • Is raising taxes, especially on businesses, a good idea during a recession? Will tax hikes raise more money than tax cuts and the economic growth that always follows them?
  • Just exactly how much will the proposed expansions of Medicare and Medicaid (and SCHIP) cost, and how can we realistically pay for those increases?

And so on.

In a nutshell, here is the plan:

We'll drastically increase Federal spending through the Stimulus Plan and a continual series of "reforms" that we will enact during the next few months. We'll offset those spending increases with some token budget cuts and a massive scale-back of our military, and major tax rate hikes. Then we'll cross our fingers and hope all the numbers work out.

President Bush lowered tax rates for every single taxpayer, so it is possible that every single tax payer will have their taxes raised. Remember the Obama campaign's waffling about the definition of "rich"? Everyone is a potential target. Enjoy that extra $13 a week while you still can.

But that's not what really worries me. I want to know how my health care is going to be impacted by all of these "reforms," especially the ones designed to drastically cut health care spending.

How do you pay a doctor for "results," without seriously compromising health care for the aged and terminally ill? If a doctor prescribes chemotherapy for a cancer patient and his cancer does not respond, does the government say, "Sorry, you didn't get the desired results, so you don't get paid"? Does a doctor tell the family of a cerebral aneurysm victim, "Well, we could treat him aggressively with drugs and emergency surgery, but right now his chances for survival are less than 50%, so the government probably won't authorize payment"? If that victim survives, is the family further told, "It looks like he will be severely mentally impaired and will require full time skilled nursing care. We've been advised to withhold food and water because he will never recover, he could linger indefinitely, and the cost of caring for him will be too great"?

This is probably the most dangerous idea put forth by the government during my lifetime. If you don't regularly pay attention to government policy debates, then you had better start paying attention now.


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Comments (15)

I, for one, am not shocked ... (Below threshold)

I, for one, am not shocked that Barry keeps being evasive about his tax plan/tax cuts. He has not idea where he is going or how we will get there. He is taking this one day at a time, which says he has no experience in getting ahead of problems. If you elect an empty suit, why would you be surprised this would happen? ww

".... such as rewa... (Below threshold)
".... such as rewarding physicians who computerize their medical records or paying doctors for results rather than procedures--could improve care...."

I see a vision:

Patient "A" has an illness that requires over and above the normal testing, diagnosis, etc.

His critical care doctor of choice, Dr. I.M. Cheapskate, weighs the potential "results" from one test/procedure that may lead to a confirmation of his diagnosis, but it may not. And besides, the "good doctor" has already decided patient "A" has a mild form of the "X" illness.

"Why take the risk, when I might not get paid" the thought bubble pops over I.M. Cheapskate's head.

It WILL happen, the only question is will it be a few isolated cases, a few hundred, or a few million.

Meanwhile, patient "A" dies of an undiagnosed case of BDS 3 months later.

My father was a doctor.<br ... (Below threshold)

My father was a doctor.
Years ago, the doctors were in charge. The doctors prescribed a treatment and the patient or their insurance company paid the doctor.
The lawyers, however, sued doctors by the hundred of thousands. The lawyers grew rich and the doctors fled into collective self defense organizations. The lawyers sued everyone, they even sued coffee sellers because the coffee was hot. Now the government wants to decide what the right amount of care is.

Why don't we fix the problem by having tort reform so the doctors can be in charge of health care again, instead of the Department of Motor Vehicles? Why is the fix to runaway lawsuits more government? Oh, that's right, the government is mostly lawyers. As long it's the Medical profession hurting, the lawyers don't care.

Yes, I know the preceding takes 50 years of medical practice history and condenses it into a few sentences.

The really interesting thin... (Below threshold)

The really interesting thing will be the impact on cancer treatment.

A really skilled cancer doctor (let's call him Doctor Good) gets the hard cases. The "one in ten lives if you're lucky" cases. Then, after a lot of hard work (and heartache), he converts that one in ten to one in nine. And he's a miracle worker.

But his results? Lousy. So he gets screwed.

Meanwhile, there's Doctor Moron, down the street. He's taking lots and lots of flu cases and other minor illnesses (sending the cancer cases and other hard ones down to Doctor Good and similar specialists), and his "cure" rate is pretty close to 99%. He makes out like a bandit...

How are we going to cut ... (Below threshold)

How are we going to cut the cost of Iraq and Afghanistan if we just committed another 17,000 troops to Afghanistan?

Oh lord, here we go again. I was in the Navy during the Clinton Years and CLEARLY REMEMBER how the morale and readiness of US forces went sharply down. Why? Because the official policy was "Do more with less." Ask us to do more, while cutting the legs from under us.

Sounds to me like he's cookin' up the perfect recipe for defeat in the mid-east, as well as MASSIVE troop losses due to low morale.

It really IS Carter v2.0.

ExSubNuc - "Oh lord, he... (Below threshold)

ExSubNuc - "Oh lord, here we go again. I was in the Navy during the Clinton Years and CLEARLY REMEMBER how the morale and readiness of US forces went sharply down." Yepper me also, ('81-'01) to say nothing of the idiot Cohan as SecDef.

The so-called "Peace Dividend" did nothing but pave the way for stretched overseas deployments, the rise of Halliburton, repair parts that took fooooeverrrrr to get to the fleet, and adding hours to a daily at-sea work schedule that hovered around 12-16 hours per day.

I can't think of a better w... (Below threshold)

I can't think of a better way for driving down the life expentancy in the country that "paying for results rather than procedures". Any patient with a expected survival rate of below fifty percent will be in danger of being denigned treatment or procedures out of sheer economic neccessity. Where is the incentive for a doctor or hospital to perform a risky but potentially life saving procedure under this proposal? At least now we could count on pure human avarice to save lives, the procedure may not work but at least the doc would make a couple bucks off it.
I am sure that there will be doctors and hospitals that would treat people regaurdless but under such a plan they would need to increase their costs just to makes endsmeet. A procedure with a 10% survivability rate would have to increase its costs exponentially because each successuful case will have 9 faild cases behind it that costs the hospital resources and time.
I am sure that there are even more downsides that are not apparent yet.

There are diseases that phy... (Below threshold)

There are diseases that physicians cannot defeat, but only hold off death or more severe conditions. Cancer has not been cured, but various treatments can keep it in check. But they may need to be changed, increased in dosage or frequency, and even then, the patient will never be considered completely 'cured'. If chemo fails, then radiation may be necessary. Should the healthcare provider be penalized because the chemo didn't 'cure' the patient?

This is also an attempt by government to second guess the physician. The bureaucrats in far-off Washington will make the decisions on what patients should get, not the doctor who actually knows and treats the patient. Liberals complain about HMO bean-counters, but with an HMO there is an actual process to mediate the decisions, and you can actually get exceptions to the rules made.

Even as a trained Board Cer... (Below threshold)

Even as a trained Board Certified Oncologist, I find the series of cancer related examples above slanted. How about we look at Cardiac DIsease? Renal Dialysis? Organ Transplant? Or simply the billions of dollars spent on various drugs to treat reflux esophagitis, elevated cholesterol and depression? Anyone want to guess how "results" payments will affect treatment for these? How about preventive health - can we pay for a preventive health exam if nothing is found, or if something bad is found (I guess we failed to prevent THAT breast cancer, no payment for that)?

Does this mean that since e... (Below threshold)

Does this mean that since embryonic stem cell research hasn't produced "results" that funding will not be forthcoming?

Somehow, I don't think so.

Frankly I don't understand ... (Below threshold)

Frankly I don't understand how the WaPo, NY Times and other left-wing birdcage liners could possibly have any financial problems. Their employee expense could be cut to virtually nothing, as they require only a fax machine or tape recorder and a few typists to reproduce the spewings of the dem party and its acolytes.

I can't help but think that... (Below threshold)

I can't help but think that this is even more sinister. What with the libtards unbridled passion for aboration on demand. What do you think the chances are that future generations will be eliminated before they are even born; and have a chance to get sick. If these morons would just put the money in my hands, I would shop for the best doctor at the best price. Problem solved.

I decided to do a little re... (Below threshold)

I decided to do a little research into Payment by Results. Its the new payment system developed by the UK's health system for provider, hospital and other institution payment. We all have seen how great their system is working. This is basically a DRG program (diagnosis related groups) for both in and outpatient care. The DRG system here for Medicare and some managed care programs for inpatients has had the effect of forcing hospitals to shorten stays, look for ways to corner the business on lucrative DRG's and try to avoid patients without lucrative diseases. Oh Michael, you have fallen for the most common trick of the Socialist, manipulating language to make the bad medicine taste better.

A very, very large part of ... (Below threshold)

A very, very large part of Medicare payments center around the last year of a typical patients life, where efforts are made to prolong a given person's life through any means possible.

I dunno how it is now, but many years ago, I saw an actual Hospital bill where a Surgeon had made the decision to do a circumcision on a 92 terminally ill male with zero chance of surviving, period. The charge was $10,000 on top of everything else.

Before I moved most recently, I drove by the biggest house in town on a regular basis. It was and is owned by a Doctor whose nickname was "Dr. Pain." He and his wife ran their "Clinic," where on any given day, you could see license plates on cars from hundreds of miles around.

If Doctors would police their own profession, there would be less need for Tort reform. That said, we did get Tort Reform in Texas and at this time, there is a waiting list for Doctors to get their license transferred to Texas because of the influx. Well, at least there was last year, I dunno about now.

Doctors load up with procedures because of Tort issues. Some doctors do more than others. I quit going to this one doctor because he loaded me up with 23 tests, most of which were pure window dressing.

The whole issues of medical care reform is complex to the point where political beliefs and ideology doesn't really translate into success and it doesn't much matter if it is liberal or conservative philosophy at the core.

As a neat example of how things work, the California Nurses Association succeeded in getting a patient/nurse ratio passed. A ton of conservatives and others howled their heads off, but lo, nursing turnover decreased and patient outcomes increased in a positive trend. Take a look at the published numbers and be prepared for a shock. Turns out that patient/nurse ratios come close to solving the nurse shortage, among other things.

At the same time, payments for Medicare are now so low, even for procedures, that many physicians limit the number of medicare patients they will treat. And who wants a government bureaucrat deciding who will and who will not be treated?

So 'round and 'round we go.


Don't be fooled. This is no... (Below threshold)

Don't be fooled. This is not about improving results. The government will define good results and bad results. This will give the government incredible power. Power to decide who gets treated, when and how.






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