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To change health care, we need more physician leaders
From Dr. Davis Liu’s post on kevinmd.com:
“We see our health care system not doing better because we do not have the structure or leadership to move the system because we have no system. There is no common leadership. There is no common culture. There is no common goal. Instead it is hundreds of thousands of doctors often working in small groups not having the types of conversation and the follow through needed to change norms or culture. This stunning gap of what we know works and what actually happens continues to harm patients. Whether accountable care organizations will be the right microculture to improve health care remains to be seen. What really matters is whether there is leadership at these organizations willing to have the difficult one to one conversations on a consistent basis. I believe that physician leaders, who both have clinical expertise and credibility, are best suited for this role.”
See on www.kevinmd.com
Healthcare Reform’s Impact on Physician Practices
On August 1 in Tampa and on August 23 in Sarasota, Akerman is co-sponsoring a Lunch ‘n’ Learn Program on the impact of healthcare reform on physician practices. If you would like to attend either event, please follow the applicable link and RSVP.
I will be one of the panelists. My topic is “Mergers, Hospitals, and Networks, oh my! — What are Physician Practices Doing to Survive?”
The Cost Disease : Why Computers Get Cheaper and Health Care Doesn’t
The idea behind Mr Baumol’s theory revolves around the fact that “productivity is increasing in all sectors of the economy, so it takes less time, man power and money to create things.” However in industries like computing, manufacturing and biotech, productivity has increased at a much faster rate compared with service industries such as healthcare, catering & education. In these industries the product on offer or service being provided is customised, therefore has an irreducible labour component as a result.
Cars can be made by robots in a high tech factory because each model is almost completely standardised by the manufacturer. However, robots cannot perform neurosurgery, heart transplants or kidney replacements which are non standardised and require different processes and components every time.
See on www.zesty.co.uk
The Gulf Between Doctors and Nurse Practitioners
Nurse practitioners believe that they can lead primary care practices and admit patients to a hospital and that they deserve to earn the same amount as doctors for the same work. Physicians disagree.
For several years now, health care experts have been issuing warnings about an impending severe shortfall of primary care physicians. Policy makers have suggested that nurse practitioners, nurses who have completed graduate-level studies and up to 700 additional hours of supervised clinical work, could fill the gap.
Already, many of these advanced-practice nurses work as their patients’ principal provider. They make diagnoses, prescribe medications and order and perform diagnostic tests. And since they are reimbursed less than physicians, policy makers are quick to point out, increasing the number of nurse practitioners could lower health care costs.
See on well.blogs.nytimes.com
Independence comes at price many doctors still willing to pay – amednews.com
Physicians in private practice say they are struggling financially compared with employed peers, but that the sacrifice is worth the autonomy.
See on amednews.com
New England Leads Nation In Primary Care – Newsroom: Bernie Sanders – U.S. Senator for Vermont
With Vermont leading the way, five of New England’s six states rank in the top six for primary care doctors per capita, according to datafrom the Association of American Medical Colleges. The sixth, Connecticut, ranks 12th. As the national shortage of primary care doctors expected to increase after the federal Affordable Care Act takes full effect next year, some are looking to New England’s states with an eye to what they’ve been doing right.
Several factors contribute to New England’s relatively strong position. Among them: strong public health programs ensuring that high percentages of residents have health coverage, meaning fewer doctors deliver uncompensated care. Massachusetts, which enacted a universal health care program in 2006, has about 97 percent of its residents carrying health coverage. In Vermont it’s about 94 percent.
See on www.sanders.senate.gov
“Physician-owned hospitals seize their moment” – amednews.com
Physician owned and operated facilities are not necessarily bad places to go for healthcare.
American Medical News, amednews.com, reported in April 29, 2013:
When the federal government sorted through the first round of clinical information it was using to reward hospitals for providing higher-quality care in December 2012, the No. 1 hospital on the list was physician-owned Treasure Valley Hospital in Boise, Idaho. Nine of the top 10 performing hospitals were physician-owned, as were 48 of the top 100.
Yet, physicians can no longer own hospitals to which they refer their patients and are severely restricted from expanding those hospitals whose physician ownership was grandfathered.
The continued distrust of physicians and their vilification by Congress and most every state legislature hurts healthcare. It’s time to unburden physicians from lawyer mandated restrictions that never made any sense — repeal the Stark Law and every other restriction on physicians’ referring their patients to entities that they have an ownership in. The laws and the regulations that have been put into place are beyond comprehension and require physicians who are trying to be compliant to spend unnecessary dollars on lawyers. There are many appropriate tools for dealing with fraud and abuse by physicians who over utilize, or bill for services not performed, or who perform sub-par medicine — they can be professionally disciplined, lose their license, go to jail, fined. On the private side, they can be sued. Congress adopts these strict liability patient referral restrictions because they are easy to enforce. That should not be the basis for interfering with an entire industry.
ACOs: The Least Agreed-Upon Concept in Healthcare? | Accountable Care Organizations
Five common arguments against accountable care organizations, commentary from experts on each, and an update on Detroit Medical Center’s ACO.
1. In the grand scheme of healthcare spending, ACOs’ savings will be slight.
2. ACOs were designed on a premise that overestimated the level of integration in healthcare.
3. ACOs won’t work when healthcare still operates in a fee-for-service system.
4. ACOs will move patients out of hospitals and hurt hospitals’ revenue.
5. ACOs take healthcare back to the 1990s.
What will prove the ACO model?
The healthcare industry is still in a waiting game as far as ACOs’ results. Although a few mature ACOs like AdvocateCare (and it’s important to keep in mind that the term “mature” means that ACO is only about three years old) have reported hopeful results from its first year. Other newly launched ACOs are not yet able to disclose results. For Medicare savings, the industry has its eye on the Pioneer ACOs, and results from those 32 organizations are expected this summer.
Supreme Court Upholds FTC Disapproval of Hospital Merger
From Akerman’s Health Law Rx Blog:
POSTED BY MARSHALL R. BURACK ON FEBRUARY 21, 2013
In a decision issued on February 19, 2013, the U.S. Supreme Court upheld the Federal Trade Commission’s efforts to prohibit a hospital merger which would substantially reduce competition. Federal Trade Commission v. Phoebe Putney Health System, Inc. involved the acquisition by a public hospital in Georgia of the only other hospital in the county. The FTC alleged that the transaction would substantially reduce competition in the market for acute care hospital services and sought to prohibit the transaction as being in violation of Federal antitrust laws.The lower court dismissed the FTC’s claim, holding that, because the acquisition was effected pursuant to Georgia’s Hospital Authorities Law, the acquisition was immune from Federal antitrust law under the state action doctrine. Under the state action doctrine, certain anti-competitive actions taken or authorized by state government or an agency of state government are immune from Federal antitrust prosecution. The Georgia Hospital Authorities Law authorized political subdivisions of the state of Georgia to create hospital authorities as special purpose entities, with the power to acquire, lease and operate hospitals and other healthcare facilities. The hospital system successfully argued in the lower court that the power to acquire hospitals granted to it by the Hospital Authorities Law immunized the acquisition of the competing hospital from Federal antitrust law under the state action doctrine.
The Supreme Court reversed the holding of the lower court, ruling that the state action doctrine protects anti-competitive behavior taken or authorized by state government only if the anti-competitive actions are undertaken pursuant to a “clearly articulated and affirmatively expressed” state policy to displace competition. The Supreme Court found that, although the Georgia Hospital Authorities Law granted public hospital authorities the power to acquire hospitals, there was no evidence in the Law that the Georgia Legislature affirmatively contemplated granting hospital authorities the power to substantially reduce or displace competition for hospital services in a particular market.
From a healthcare policy perspective, the case demonstrates support for competition among providers as a positive value that should be protected, absent a very specific indication of state intent to limit competition. From a more general jurisprudential perspective, the case is a surprising example of the Roberts Court, in a unanimous decision, limiting the authority of the states and supporting and expanding Federal antitrust powers.
Actually, Mr. Brill, Fixing Healthcare Is Kinda Simple | Wired Science | Wired.com
When you need health care, you enter not a market but a con game in which you’re first a guarantor and source of profit, and second a patient. Wired Science blogger David Dobbs explains why the government needs to step up. See on www.wired.com
Patients have no clout in so-called market driven healthcare because of its fragmented delivery and billing systems. Having insurance further mystifies the process and hides the information necessary to make market decisions. Something like a patients union is needed to equalize the playing field. For now, Obamacare is all that patients have to give them some protection against the two Titans in healthcare who have all the market power.
Joseph Rugg's Health Law Blog 