Sunday, February 14, 2010

More Healthcare Savings

      In my blog A Good Idea From the Right of 02/13/10, I mentioned the cost of preventive medicine which physicians are almost compelled to perform in order to avoid litigation. Without doing something to mitigate this problem, healthcare costs will continue to rise.
      In a nutshell, what makes this cost difficult to control is that medical suppliers are paid according to the number of procedures they perform. The more procedures they perform, the more they get paid.
       Republicans are concerned that the establishment of information-gathering panels (Sarah Palin’s “death panels”) to determine what treatments are most effective for specific medical conditions would result in government micromanagement of the healthcare system. The fear is that such management would lead to the rationing of treatment by government bureaucrats. In fact, Senate Republicans recently introduced "antirationing" legislation to bar the government from using comparative-effectiveness research, "a common tool used by socialized health-care systems," for cost control.
      My own expectation of this is that in the worst case scenario, treatment might be rationed by the same accountants and actuaries who now perform this function for insurance companies. For those who presently do not have health insurance, rationing is on the basis of how much money one has.
      But this need not be the case. Such panels could simply collect evidence-based information and pass it on to doctors. In discussions of various courses of treatments to follow, patients would be able to compare the effectiveness of the options available. As long as physicians are not required to follow the guidelines, I don’t see why both Democrats and Republicans wouldn’t vote for it, although it is likely that Republicans would raise their passé specter of “spend, spend, spend.” This in spite of the likelihood that huge savings would follow as a result of the elimination of countless unnecessary procedures.
      One hurdle which needs to be overcome is the hodge-podge of information gathering systems presently in use. A standardized electronic network needs to be established in order that the efficacy of various treatments reaches the panels, and is disseminated to doctors in a timely fashion, without compromising patient privacy. To this end, a massive amount of work remains to be done.
      However, without incentives to use it, information alone will not lead to reform. Obama wants to make evidence-based medicine financially attractive so that providers are rewarded rather than punished for reducing readmissions and unnecessary procedures. "We can't just do research and let it sit on a shelf," Budget director Peter Orszag says.
      Incentives suggested are extra reimbursements for providing primary care, prevention and computerization, and discouraging wasteful preventive medicine by limiting malpractice lawsuits when doctors have followed the recommended practices.
      But the biggest savings depend upon changing the way Medicare reimburses providers. For example, reimbursements for following proven treatments could be increased; if patients want alternative treatments they would have to pay for them themselves. If Medicare leads the way, insurers will follow.
      One last thought: The key to changing the system is the mindset of medical providers. No one should be surprised if they fight tooth and nail to keep the current “pay for procedures performed.” It’s part of the capitalist system to fight change, particularly if it is going to have a major effect on one’s pocketbook.

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