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  • The Wasting of Taxpayer Money October 29, 2014
    by G. Keith Smith, MD If you are looking for proof of the fact that the wonderful folks in D.C. are more interested in lining the pockets of their pals than demonstrating good stewardship of the loot from the robbery …
  • Giving Birth in America is Most Expensive in the World October 27, 2014
    While a woman is preparing for giving birth, one worry she doesn’t want to have is about the cost of delivery. Insured women are finding that some policies do not cover maternity care, services that most often do not have …
  • Physicians are Not Medicine’s Top Earners October 24, 2014
    Physicians are the most highly trained members of the medical industry’s force, yet have median compensation.  The largest salaries go to the Medicrats who oversee the business of medicine. Insurance CEOs average $584,000 compared to surgeons ($306,000) or a general …
  • Health Benefits of Honey October 22, 2014
    Honey has been used as a natural sweetener long before sugar. Bees collect pollen from  plant to plant, which is passed along from bee to bee until it eventually is deposited into the honeycomb. They beat their wings to evaporate …
  • Rotten Food and the VA Hospital October 20, 2014
    by G. Keith Smith, MD Imagine for a moment that you own and operate a restaurant knowing that if you provide spoiled food and rotten service, you will subsequently make more money.  You openly employ strong-arm and intimidation tactics to …
  • Hospitals want patients to pay in advance October 17, 2014
    Hospitals are asking for payments from patients before they leave the facility so they don’t end up with unpaid bills. Knowing the costs before the procedure is important because insurance deductibles are increasing and so are procedure costs. Obamacare policies …
  • Massachusetts is First State To Require Health Care Price Tags October 15, 2014
    Massachusetts has started a new era of shopping for medical care. You can go to your health insurer’s website and find the price of everything you may require listed, from an office visit to a scan or procedure. For the …
  • Physicians Remove Government from Medical Equation October 13, 2014
    by Gerard Gianoli, MD Doctors in Nevada and across the country are protesting against the government’s intrusion into health care, but we aren’t voicing our concerns using bullhorns and pickets. Instead, many of the state’s 5,400 physicians are protesting silently …
  • Revolutionary Idea Could Change Medicine October 10, 2014
    For those of us who get woozy when having blood drawn for routine testing, a simple pin prick may be the blood test of the future. Elizabeth Holmes, the CEO and founder of Theranos, says that her company can run …
  • Why Accountable Care Organizations Are Failing October 8, 2014
    by Richard Amerling, MD Accountable Care Organizations (ACOs), a key piece of the Affordable Care Act (“ObamaCare”) “reform” plan, are failing because they must fail. ACOs are based on faulty assumptions, poor economics, and junk science. They would not exist …
  • Common Sense Travel Restrictions to Stop Ebola: Dr. Jane Orient October 7, 2014
    Dr. Orient appears on Cavuto – October 6, 2014
  • What Employers Can Do To Reduce The Cost Of Obamacare October 6, 2014
    The Obamacare mandate will be enforced on large employers in 2015 and small employers in 2016. Large companies who self-insure can have a plan that does not cover hospitalization, mental health care, or emergency room visits.  Small companies have to …
  • Ralph Weber Talks About Fixed Pricing – Video October 3, 2014
    You can ask the price of a procedure at a hospital, but may ask several different people before finally getting an answer. Listing set prices for procedures has lead to medical tourism. People will travel to get the price they …
  • Here’s The Thing #5 Fixed Pricing HD October 3, 2014
  • Economists Say Third-Party Payment Key to Increases in Medical Cost October 1, 2014
    The rapid increase in medical costs starting in the 1970s is commonly ascribed be market imperfections. However, federal and state governments have long suppressed the functioning of the market system in the medical industry, write Maureen Buff and Timothy Terrell, …
  • Health Insurance Exchanges Waste Taxpayer Money September 29, 2014
    Obamacare may surpass Cash for Clunkers to become the prime example of federal taxpayer resource mismanagement. For every dollar in premiums for exchange coverage, taxpayers paid 94 cents in subsidies to either enroll people or encourage them to do so. …
  • Mesothelioma: An avoidable cancer? September 26, 2014
    by Sue Redmond Did you know? Mesothelioma is an aggressive cancer that attacks the lining of the body cavity called the mesothelium (80% of which occur within the lining of the lungs). The only known cause to mesothelioma is exposure …
  • Government Healthcare is Breech of Contract September 24, 2014
    by G. Keith Smith, MD One of the smartest people I have ever met is a property and contracts lawyer, someone from whom I have gleaned countless and valuable insights over the years.  He has advised me, among other things, …
  • Dr. Alieta Eck Campaign Update September 24, 2014
    Dr. Eck http://EckForCongress.com speaks to colleagues at AAPS 71st annual meeting on September 5, 2014.
  • Is There A Provider In The House? September 22, 2014
    by Marilyn Singleton, MD, JD Physicians have a proud heritage. We can boast Dr. Benjamin Rush, a founding father, signer of the Declaration of Independence, Surgeon General of the Continental Army, and opponent of slavery. And Dr. James Derham, born …

The Wasting of Taxpayer Money

by G. Keith Smith, MD

If you are looking for proof of the fact that the wonderful folks in D.C. are more interested in lining the pockets of their pals than demonstrating good stewardship of the loot from the robbery of taxation, look no further. The folks at CMS (Medicare) have interestingly decided to pay physicians not employed by a hospital system amounts so low that doctors in record numbers are opting out of Medicare completely.  Simultaneously, CMS is double paying for physician services provided by physicians employed by hospital systems.  If you suspect that this is an effort to drive as many physicians out of private practice as possible, you go to the head of the class.

Many physicians are succumbing to this pressure, exacerbated, as well by the purchase icd10codesexpense of the mandatory electronic medical records systems and the American Medical Association’s new “ICD-10” code mess.  Many doctors are not following this script, however, either completely retiring from medical practice or seceding from the system altogether, refusing payment from any third parties whatsoever.

The deliberate and intended setup is clear:  fewer doctors available to see patients and many of these physicians are now salaried hospital employees whose compensation is not greatly affected by the numbers of patients they see.  Any guesses about what this looks like 5 years from now?  Countries with single payer systems will all tell you that rationing care will inevitably balance any health care budget.

Very paradoxically, these efforts will and are already beginning to backfire, an alternative and free market model of health care delivery emerging to satisfy those both:

1)waiting in lines and

2)the new healthcare consumers who are motivated shoppers due to their new and giant insurance policy deductibles.

For all their work to crush the market, for all their efforts to destroy the private practice of medicine, one “good news” thing remains true:  the corrupt and central planners never get it right.

http://surgerycenterofoklahoma.tumblr.com/post/97838597442/squandering-taxpayer-loot

Smith MD, G. Keith. “Squandering Taxpayer Loot.” Blog, September 2014. Web. 28 Oct 2014.

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Posted in Business and Medicine Tagged , , , , , , , |

Giving Birth in America is Most Expensive in the World

While a woman is preparing for giving birth, one worry she doesn’t want to have is about the cost of delivery. Insured women are finding that some policies do not cover maternity care, services that most often do not have a clear price and must be negotiated with hospitals to get any dollar amount. Many women are getting this sticker shock in the U.S., where delivery charges have tripled since 1996. Maternity and newborn care is the biggest category of hospital payout for insurers and state Medicaid programs. American wompregnanten with normal pregnancies get more of everything, necessary or not. In 2011, 62% of women covered by private plans lacked maternity coverage. Women with coverage have higher co-pays and deductibles. Prices for childbirth rose nearly 50% from 2004 to 2010, with out-of-pocket costs increasing four times. American women with insurance will pay an average of $3,400 out of pocket.

Ireland guarantees free maternity care, whereas Switzerland, France, and the Netherlands top out at about $4,000. French mothers stay in the hospital nearly a week. American charges that used to be lumped together are now broken down meaning more bills and inflated costs. Add up all the bills and the total is startling. Other developed countries provide a flat fee to hospitals and doctors, and women have a wide array of choices. Expenses are also on the rise because mothers are older now and obstetricians have the highest malpractice insurance, yet less than 25% of payments go to the obstetrician. More than 30% of American women have C-sections or induced labor – far higher than those of other developed countries at rates higher than deemed necessary.

Women with the best insurance can still end up with high prices. Qualifying for assistance like Medicaid or other subsidies is hard when employed. Couples must budget their finances well to brace for future bills. Some hospitals are now offering all-inclusive pregnancy packages, which include standard hospital, doctors’, and testing fees for about $5000. Under Obamacare, new insurance plans must include maternity coverage, but does not explain what services are included. The states cover more than 40% of births nationally under the Medicaid system, under which patients pay an average of $9,000 for a vaginal birth and $13,000 for C-section delivery. Insured women are still getting the necessary prenatal care, despite the rising out-of-pocket costs.

http://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html

Rosenthal, Elisabeth. “American Way of Birth, Costliest in the World.” Health. The New York Times, 30 June 2013. Web. 26 Oct 2014.

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Posted in Cost of Health Care Tagged , , , , , , , |

Physicians are Not Medicine’s Top Earners

doctorgroupPhysicians are the most highly trained members of the medical industry’s force, yet have median compensation.  The largest salaries go to the Medicrats who oversee the business of medicine. Insurance CEOs average $584,000 compared to surgeons ($306,000) or a general doctor ($185,000). The bulk of nonsalary compensation for administrators is from stocks and options. It is incredible that insurance executives are paid so much more than highly trained surgeons. Barnabas Health lists more than 20 vice presidents who earn over $350,000 per year. Hospitals claim that the large pay is necessary to attract those who have the expertise needed. Administrative costs are 20 to 30% of the U.S. health care bill, far higher than any other country. American insurers spent more than twice as much as any other country on administrative costs.

Doctors are growing very frustrated with all the business people interfering with the practice of medicine and are burdened by the excessive administrative costs, which are affecting the cost for medical care. Doctors are pushing back against the system: This past spring, doctors in northern Wisconsin created an ad in their local medical journal demanding widespread reforms to lower prices. This movement was started when a surgeon, Dr. Hans Rechsteiner, discovered that an appendectomy ($1700) patient was billed over $12,000. Physicians have a stressful job that they find fulfilling and want to do well for their patients – without the financial burden and regulatory headaches.

http://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are-not-the-big-cost.html

Rosenthal, Elisabeth. “Medicine’s Top Earners Are Not the M.D.s.” Sunday Review. The New York Times, 17 May 2014. Web. 23 Oct 2014.

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Posted in Business and Medicine Tagged , , , , , , , |

Health Benefits of Honey

Honey has been used as a natural sweetener long before sugar. Bees collect pollen from  beecombplant to plant, which is passed along from bee to bee until it eventually is deposited into the honeycomb. They beat their wings to evaporate the water as it solidifies into honey. Honey can be stored indefinitely if not exposed to air or water.  There are 300 kinds of honey in America.

Honey Makes Excellent Cough Medicine – It relieves irritation in the mouth and throat providing a protective coating. Honey works as well as some over the counter cough medicines, soothing cough and other sleeping difficulties.

Honey Can Treat Wounds – Honey has antibacterial, antifungal, and antioxidant features for treating wounds. Manuka honey made from flowers of the Manuka bush has been found to destroy more than 250 strains of bacteria including MRSA, MSSA, and VRE. Manuka has extra antimicrobial qualities not found in any other honey. Honey releases hydrogen peroxide through an enzymatic process. Any type of unprocessed honey helps wounds and ulcers heal when applied topically.

Honey Improves Your Scalp – Honey diluted with warm water improves scalp conditions that cause dandruff and itching.

Honey Boosts Your Energy – If you want a quick energy boost, a spoonful of honey will work.  There are also energy bars made with honey.

sb10067340d-001Honey Reduces Allergy Symptoms – Locally produced honey contains local pollen spores. By taking a teaspoon of locally made honey each day, you can build up your immunity to the allergens.

 

Honey attracts and retains moisture, making it a great addition to personal care products.

  • Honey Hair Conditioner: Mix 1/2 cup honey with 1/4 cup olive oil. Let sit on hair for 30 minutes. Then shampoo as normal and rinse.
  • Honey Body Lotion: Mix 5 tablespoons honey, 2 tablespoons rose oil, 2 cups almond oil. Apply to dry skin.
  • Honey Almond Scrub: Mix 3 teaspoons honey, 1 teaspoon olive oil, 6.5 tablespoons crushed almonds. Rub the scrub on your face gently and rinse with warm water. Honey also fights acne if used as a face wash.

 

Not all honey is the same.  Some have 100 times more potent antibacterial activity thanhoneyJars others. More than 75% of honey in American supermarkets is so processed that it has no medicinal value, nearly void of pollen. Most of this “fake” honey is made in China. Farmers markets, co-ops, and natural stores have full, proper amount of pollen. Be sure the honey you choose is raw, unfiltered, and from a trusted source.

Honey is high in fructose, nearly 53%. Eating raw honey in moderation provides many health benefits as listed above.

http://articles.mercola.com/sites/articles/archive/2014/10/20/health-benefits-honey.aspx

Mercola MD, Joseph. “5 Things You Didn’t Know About Honey.” Health. Mercola.com, 20 Oct 2014. Web. 21 Oct 2014.

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Posted in Health (taking care of yourself) Tagged , , , , , , , |

Rotten Food and the VA Hospital

by G. Keith Smith, MD

Imagine for a moment that you own and operate a restaurant knowing that if you provide foodservicespoiled food and rotten service, you will subsequently make more money.  You openly employ strong-arm and intimidation tactics to keep any conscientious employees from revealing what is really going on in the kitchen.  Sound like a restaurant people would want to frequent?

This is the VA hospital system.  High mortality rates, patient neglect, extreme waiting lines, intimidation of wannabe whistleblowers, you have it all.  And a 17 billion dollar bonus from Washington for providing this fine service.  One of the three senators to vote against rewarding this incompetence and malevolence was Oklahoma’s own Dr. Tom Coburn, soon retiring to his plough.

Awarding more loot to the VA after the revelation of the most recent and deadly fiascos in their hospital system should come as no surprise, though, as any government program that fails only does so because not enough money was allocated in the first place, right?  Coburn, cited a 60% budget increase at the VA in the last few years to argue against the idea that a lack of loot was the trouble.  He basically said the congress was about to give the alcoholic VA another drink.  Not exactly what they need.

What they need is to not exist at all.  Any one who claims to be a fan of single payer health care or government-provided health care should tour or possibly receive their “healthcare” at a VA hospital.  Nothing could open such an individual’s mind to market alternatives any faster.  Compassion and competence doesn’t typically come from the untouchable folks who are paid the same whether they do or don’t provide compassion and competence.  If you think I am kidding, notice carefully the number of times you will see the difficulty firing someone at the VA is referenced when you read about pending reforms.

The free market destroys businesses and institutions providing the type of “care” rendered at the VA, a concept the Austrian economists refer to as “creative destruction.”  This powerful cleansing mechanism of the market allows for a better allocation of resources to those businesses or institutions that provide the products and services that people actually want.  No such mechanism exists in governmental programs.  The opposite incentive exists, rather, to generate sufficient complaints and misery, a strategy which guarantees even more taxpayer money.  Unfortunately with the disaster of the VA’s version of Obamacare, we have seen this demonstrated once again.

http://surgerycenterofoklahoma.tumblr.com/post/94001599222/poisonous-restaurants-and-the-va-hospitals

Smith MD, G. Keith. “Poisonous Restaurants and the VA Hospitals.” Blog, Aug 2014. Web. 19 Oct 2014.

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Posted in Health Care News Tagged , , , , , , , |

Hospitals want patients to pay in advance

hospital-art-toyHospitals are asking for payments from patients before they leave the facility so they don’t end up with unpaid bills. Knowing the costs before the procedure is important because insurance deductibles are increasing and so are procedure costs. Obamacare policies on the exchanges are raising premiums even quicker. If a patient cannot afford their hospital bill, payment plans and loans are available. They have the option of waiting for their insurance to process their claim. Northwestern Memorial Hospital in Chicago has a financial counseling program, and is planning to expand it to all departments in the next few years. The average deductible for an employer plan is up almost 50% from five years ago, with the most common being $5000. Receiving payments in advance improves hospitals’ profit. Uncompensated care makes up 6% of hospital expenses.

http://money.cnn.com/2014/09/29/news/economy/hospitals-deductibles-payments-patients/index.html

Luhby, Tami. “Hospitals ask patients to pay upfront.” Economy. CNN Money, 29 Sept 2014. Web. 16 Oct 2014.

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Posted in Hospital Bills Tagged , , , , , , , |

Massachusetts is First State To Require Health Care Price Tags

Massachusetts has started a new era of shopping for medical care. You can go to your health insurer’s website and find the price of everything you may require listed, frromneycareom an office visit to a scan or procedure. For the first time, health care prices are public. Two years ago, Massachusetts passed a law that pushed health insurers and hospitals to start making this highly guarded information public. As of October 1st, Massachusetts is the first state to require that insurers offer real prices.

http://www.kaiserhealthnews.org/Daily-Reports/2014/October/08/state-roundup.aspx

“State Highlights: Mass. First To Require Health Care Price Tags; Health Disparities In Wis.” Daily Reports. Kaiser Health News, 8 Oct 2014. Web. 14 Oct 2014.

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Physicians Remove Government from Medical Equation

by Gerard Gianoli, MD

Doctors in Nevada and across the country are protesting against the government’s Image courtesy of [dream designs] FreeDigitalPhotos.net2intrusion into health care, but we aren’t voicing our concerns using bullhorns and pickets. Instead, many of the state’s 5,400 physicians are protesting silently through their practice decisions.

Having graduated from medical school 28 years ago, I have witnessed firsthand the transformation of our country’s health care system. Then, medical practice focused more on the deeply personal decisions made between doctor and patient. Today, however, bureaucrats are inserting themselves ever deeper into every aspect of health care.

Physicians across the country are responding to this evolution — and most recently the Affordable Care Act — by shielding their practices from government interference. Chief among them: Opting out of Medicare and Medicaid, transitioning to practices that don’t accept insurance, and starting “concierge” practices that charge annual fees.

All of these options ultimately serve the same purpose: They free physicians to spend more time with patients.

Consider the number of doctors opting out of or otherwise avoiding Medicare and Medicaid. In 2014, one in four physicians either refuse or are limiting the number of Medicare patients they see, according to a new study conducted by the Physicians Foundation. In recent years, a similar number of physicians simply stopped accepting Medicaid altogether. This is because of many factors, including unpredictable reimbursement rates and burdensome regulations, and more.

These ailments have become so acute that thousands of other physicians are dropping out of these government-run health care programs altogether. According to the Centers for Medicare and Medicaid Services, nearly 10,000 physicians opted out of Medicare in 2012 — a 160 percent increase from 2009. At a time when 11,000 baby boomers are turning 65 every day, this population segment can ill afford a shortage of physicians. Yet that is exactly what government intrusion into health care is causing.

Physicians are instead embracing practice models that limit government interference. This meddling can come either directly through government-paid health care — e.g., Medicare and Medicaid — or indirectly through regulations applied to private insurance policies — e.g., the Affordable Care Act.

For evidence, witness the emergence of “concierge” medicine and third-party-free practices. The first charges patients periodic membership fees; the second refuses insurance coverage altogether, thus dodging the government regulations that come with it.

The Physicians Foundation study found that fully 20 percent of physicians either practice or are planning to practice some form of concierge or third-party-free medicine. This number has doubled in only two years. No wonder: By eliminating the cumbersome insurance billing process, doctors can save an average of 40 percent in overhead expenses, leading to lower fees.

More importantly, doctors can spend more time helping patients, rather than fighting with insurers and bureaucrats on the phone.

Doctors are reacting to government intrusion into health care in other ways, too. Over the last decade, there has been a dramatic migration of physicians away from small private practices toward employed positions at larger hospital-owned medical networks.

As recently as 2008, fully 62 percent of physicians described themselves as independent practice owners. Today, that number has dwindled to just 38 percent. During that same period, the number of hospital-employed physicians surged, from 38 percent in 2008 to 53 percent in 2014.

This is a troubling trend. Hospital employment inserts yet another wedge between doctors and patients. On top of Washington’s regulatory burdens, hospitals make still greater paperwork and compliance demands. Physicians are thus dealing with multiple and compounding intrusions into the doctor-patient relationship — yet they have to accept it. Thanks to the Affordable Care Act and other bureaucratic attacks, they can’t financially survive as private practitioners.

Through all of this, doctors’ primary concern is our patients’ well-being. Yet Washington’s ever-increasing meddling limits our ability to help them. Until politicians and bureaucrats stop encroaching on the waiting room, the treatment room, and everything and everyone in between, more doctors will seek to help their patients by avoiding the government.

Gerard J. Gianoli, M.D., is a neuro-otologist who practices in Covington, La.

http://www.reviewjournal.com/opinion/doctors-subtract-government-medical-equation

Gianoli MD, Gerard J. “Doctors subtract government from medical equation.” Opinion. The Las Vegas Review-Journal, 3 Oct 2014. Web. 12 Oct 2014.

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Posted in Free market medicine Tagged , , , , , , |

Revolutionary Idea Could Change Medicine

blood-testFor those of us who get woozy when having blood drawn for routine testing, a simple pin prick may be the blood test of the future. Elizabeth Holmes, the CEO and founder of Theranos, says that her company can run hundreds of tests on a drop of blood more quickly than vials and at less cost. She developed this company because traditional blood testing is difficult, expensive, and prone to error (not to mention a cause of anxiety to some). The company’s methods are protected by dozens of patents. Their new blood tests are done at your nearest Walgreens and can have results in four hours, saving the time and money of an office visit. One drop of blood can be used for dozens of tests, rather than having separate blood drawn for each test. Theranos lists their prices online and are quite affordable. Each test is 50% of Medicare/Medicaid reimbursements. Patients also have access to their own results, so they can change their diet and lifestyle accordingly.

http://finance.yahoo.com/news/womans-revolutionary-idea-made-her-143400959.html

Loria, Kevin. “This Woman’s Revolutionary Idea Made Her A Billionaire — And Could Change Medicine.” Yahoo Finance. Yahoo, 4 Oct 2014. Web. 9 Oct 2014.

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Posted in Health Care Innovation Tagged , , , , , , , |

Why Accountable Care Organizations Are Failing

by Richard Amerling, MD

acoAccountable Care Organizations (ACOs), a key piece of the Affordable Care Act (“ObamaCare”) “reform” plan, are failing because they must fail. ACOs are based on faulty assumptions, poor economics, and junk science. They would not exist in a truly free market, and are best viewed as a product of government central planners and crony capitalism.

I first characterized ACOs about a year ago as little more than HMOs with lipstick in response to a report on the poor performance of the 32 pioneer ACOs. Now comes news that three more of the original groups will jump ship, leaving only 19 of the original 32 still on board. A nearly 50 percent attrition rate should be seen as a death knell for the concept, as these were likely the best of the best, and the inducements most generous. Reasonable people would head back to the drawing board. But we are dealing with government bureaucrats, health policy wonks, and administrators. They will damn the torpedoes and push on at flank speed.

What is wrong with the ACO model? Pretty much everything. The idea that an organization with control over health care dollars will be able to improve actual hard outcomes (as opposed to secondary endpoint numbers) is a collective fantasy. Keeping patients healthy and out of hospitals is already the goal of all physicians I know. The only problems we encounter in collaborating are those imposed by federal regulations (HIPAA). The real problem is that outpatient primary care physicians are not paid enough to devote adequate time to patients with complex problems. The ACO does not solve this problem. Rather, it creates financial disincentives to hospitalize patients or to refer for advanced care (similar to HMOs). This will lead to poor outcomes for the sickest patients, and ultimately, higher costs.

Money saved by rationing care (or by improving care; let’s be optimists), will be consumed largely by the considerable administrative infrastructure required of the ACO. This includes hiring even more administrators to track outcomes and costs, installing and maintaining expense electronic health record systems, and training of staff. EHRs have many problems, do not improve productivity, and impinge on the patient-physician relationship, impairing quality of care.

“Quality” benchmarks are numerical targets for blood pressure, blood sugar, cholesterol, etc., determined by various guideline panels, most of which are dominated by industry-supported physicians. This will lead to inappropriate over-treatment in many individuals, with greater expense and worse outcomes over time. For example, aggressive targeting of low blood sugar has been shown to cause weight gain and higher mortality in patients with type 2 diabetes. It’s not a coincidence that Big Pharma heavily supported ObamaCare.

ACOs are based on the assumption that fee-for-service medical practice is responsible for the high cost of medical care. This is demonstrably false. Direct third party payment, spearheaded by Medicare, is the culprit.

And of course, when Uncle Sam is your partner, there is always risk that rules and payment will be changed, sometimes arbitrarily and without warning. As reported in Modern Healthcare, “as ACOs grow more efficient and Medicare adjusts savings targets accordingly, it may also grow increasingly difficult for ACOs everywhere to earn savings.” Furthermore, “Medicare’s ACO programs so far have produced inconsistent results, some of which policy experts and ACO executives have blamed on how Medicare calculates how much ACOs potentially saved the program. Last week, the CMS announced that the initiatives saved Medicare $817 million through 2013. Dozens of participants shared $445 million of that amount, but three-quarters of ACOs saw nothing after failing to do sufficiently well against the financial benchmarks” [emphasis mine]. So, only a handful saw any real profit, and you can be sure Medicare will alter their formula to not allow whatever they consider to be excessive profit.

It is clear that for ACOs to be profitable, they will need to engage in the old HMO practice of cherry-picking healthy patients. Last week I saw a 65-year-old woman with kidney disease on top of severe lung, liver and heart disease. It took more than an hour just to sort through her records and medications. ACOs will go out of their way to avoid recruiting patients such as this. The only hope for such patients is within the traditional fee-for-service system.

Our hope is that this system is allowed to survive.


Richard Amerling, MD is an Associate Professor of Clinical Medicine and a renowned academic nephrologist at the Beth Israel Medical Center in New York City. Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981. He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania. He has written and lectured extensively on health care issues and is President of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians’ Declaration of Independence and is a seasoned speaker and on-air contributor.

http://www.aapsonline.org/index.php/site/article/why_accountable_care_organizations_are_failing/

Amerling MD, Richard. “Why Accountable Care Organizations Are Failing.” What’s New. Association of American Physicians and Surgeons, 6 Oct 2014. Web. 7 Oct 2014.

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Posted in Health Care Reform Tagged , , , , , , , |
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