Don’t open wide: Annual check-ups are pretty much useless

I suspect this underestimates the problem. I think a lot of ‘chasing incidentalomas’ in medicine start here:

Two doctors in Colorado scanned through 14 randomized, controlled studies involving 182,000 patients. The articles spanned from 1963 to 1999. The doctors looked at whether those who had regular check-ups had higher mortality rates than their counterparts who dodged such visits. They could not find a difference.“General health checks do not improve important outcomes and are unlikely to ever do so based on the pooled results of this meta-analysis spanning decades of experience,” write authors Allan Prochazka and Tanner Caverly. ”There remains a belief in the value of general health checks despite the accumulating evidence. This belief is buoyed by screening advocacy groups and insurance coverage, and they have ramifications for patient welfare and health care costs.”

via Don’t open wide: Annual check-ups are pretty much useless.

They point out that Canada actually stopped paying for ‘routine checkups’ in 1979.

(Please understand I’m not including chronic condition maintenance in this category, like CHF or diabetes visits, as once you’ve got a chronic condition that’s where office visits probably really do help).

26 States Decline ObamaCare Exchange; ‘Administrative Nightmare’ Seen – Investors.com

So, this is an inauspicious beginning…

The federal government will likely be involved in running the ObamaCare exchange in at least 30 states, 26 of which expressly declined to establish state exchanges. One health-policy expert refers to it as an “administrative nightmare” for the Department of Health and Human Services.

Friday was the deadline for a state to let HHS know if it planned to establish a state exchange. Thus far only 18 states and the District of Columbia are planning on doing so.

Enrolling them will likely prove a daunting challenge for the federal government.

“HHS expected to be running zero exchanges,” said Michael Cannon, director of health policy studies at the libertarian Cato Institute. “They have been throwing money at states to bribe them to start exchanges. HHS maintains they’ll have these things up and running by October 2013. I don’t know anyone who is confident about that and I’m ready to predict that they will not.”

via 26 States Decline ObamaCare Exchange; ‘Administrative Nightmare’ Seen – Investors.com.

Why aren’t the States playing? They aren’t interested in being a conduit for plans they don’t run, the state gets all the blame for decisions they don’t make. (That, plus general opposition to the whole idea: it’s your plan, you run it…).

All this, by the way, projected to insure 25 million Americans through this plan in the next seven years. None of this controls costs, or spending.

CBS News: (some) ER Docs pressured to admit at a for-profit chain

For the record, nobody’s ever told me I need to admit more (or less).

Hospitals: The cost of admission

December 2, 2012 4:42 PM

Steve Kroft investigates allegations from doctors that the hospital chain they worked for pressured them to admit patients regardless of their medical needs.

 

First thoughts: this HMA company’s about to get an ugly look-at by the feds. I feel bad for the docs (and the admins) that blew the whistle.

Wonder if any of them filed a Qui tam action?

A physician takes his flu vaccine under protest

Good, well written rant-

A physician takes his flu vaccine under protest

by Doug McGuff, MD on November 27th, 2012in Physician

To hospital administration,

I am writing this letter to inform you that when I take my mandated influenza vaccine I will be doing so under protest and with the understanding that failure to do so could result in loss of my ability to earn income for myself and my family. Unfortunately, I do not qualify for any of the exemptions allowed by our facility. Since I am not religious, I have no religious objections, I am not allergic, and I have never had Guillane-Barre as a result of a flu vaccine. My objection to the vaccine is based on rational evidence and moral indignation.

via A physician takes his flu vaccine under protest.

Oklahoma Doctors vs. Obamacare – YouTube

The title is theirs, and it’s unnecessarily inflammatory, really it should be “Price Transparency in Medicine vs the Traditional Model”.

Three years ago, Dr. Keith Smith, co-founder and managing partner of the Surgery Center of Oklahoma, took an initiative that would only be considered radical in the health care industry: He posted online a list of prices for 112 common surgical procedures.

via Oklahoma Doctors vs. Obamacare – YouTube.

More of this, please, much more.

Movin’ Meat: Are low acuity patients congesting the ER?

Big big Kudos to MovinMeat for bringing data to an argument that seemed doomed to opinion-lock.


I have pointed out in the past that my BS-meter starts pinging when people start claiming that the ER is only caring for emergent patients and that non-emergency cases are rare. So this set me off, of course. My perception — and that of many of us in the trenches — is that we are absolutely beset by non-emergencies and that the ER is viewed by many as the "convenience clinic," if not the "vicodin clinic." But is this true? How can we quantify this?

via Movin' Meat: Are low acuity patients congesting the ER?.

It’s a terrific post. It’s worth your time.

More ABA Silliness – ProfessorBainbridge.com

Where have we experienced this before?

Christine Hurt reports on an American Bar Association effort to promote breed neutral vicious dog laws.

My question: WTF? Why is this the business of the ABA?

via More ABA Silliness – ProfessorBainbridge.com.

Oh, yeah. The AMA. Same political, and therefore membership trajectory.

L.A. City Council votes 14-0 to ban medical marijuana shops – latimes.com

In the latest attempt to regulate what many say is an out-of-control proliferation of medical marijuana dispensaries in Los Angeles, the City Counted voted 14-0 Tuesday to ban pot shops.

Under the ban, each of the 762 dispensaries that have registered with the city will be sent a letter ordering them to shut down immediately. Those that don’t comply may face legal action from the city.

via L.A. City Council votes 14-0 to ban medical marijuana shops – latimes.com.

Two somewhat disparate thoughts:

  • where does this leave the ‘legalize it” movement? They did, they were an out of control nuisance to the point LA shut them down, and
  • if Government is in control of your industry, they can kill it.

A Death Knell for Press Ganey? | WhiteCoat’s Call Room

Not only does “satisfaction [have] little or no correlation with Health Plan Employer Data and Information Set quality metrics,” but, according to the results of this study, hospitals that push to have the highest satisfaction scores may be harming or even killing their patients.

via A Death Knell for Press Ganey? | WhiteCoat’s Call Room.

I’m not ever going to get tired of this.

Skeptical Scalpel: Patient satisfaction and reality

You. Don’t. Say.

Christmas came early for us skeptics this year. In a landmark study, certainly one of the most interesting and thought-provoking of the year-to-date, researchers from the University of California-Davis found that the more satisfied patients were with their physicians, the higher their hospital admission rates, prescription costs and total costs were. And patients with the highest level of satisfaction with their doctors had higher mortality rates compared to those patients least satisfied with their doctors.

via Skeptical Scalpel: Patient satisfaction and reality.

Anecdotally, I think that the push for higher patient satisfaction has led directly to underperforming docs doing things they wouldn’t normally do. This isn’t good medicine, it’s playing a very dangerous game.

CARPE DIEM: Do Medical School Acceptance Rates Reflect Preferences for Preferred Minority Groups?

Interesting.

1. For those students applying to medical school with average GPAs (3.40 to 3.59) and average MCAT scores (27-29), black applicants were almost three times more likely to be admitted than their Asian counterparts (85.9% vs. 30%), and 2.4 times more likely than their white counterparts (85.9% vs. 35.9%). Likewise, Hispanic students…

via CARPE DIEM: Do Medical School Acceptance Rates Reflect Preferences for Preferred Minority Groups?.

Interactive: Who Are the Uninsured in Texas?

Nearly a quarter of the Texas population lacked health insurance in 2010, according to the most recent data released by the American Community Survey, which the U.S. Census Bureau conducted. That’s more than 5.7 million Texans.It’s likely that someone you know — and probably one you wouldn’t have guessed — doesn’t have health insurance. More than half of the uninsured are employed. More than a third have an annual household income above $50,000. And more than 1 million have college experience or post-secondary degrees.

via Interactive: Who Are the Uninsured in Texas?.

Very nicely done.

If I get a lesson from this, it’s “Stay in School. kids!” (If you live that long).

Doc Fix Just Got More Expensive

Sustainable. They keep using that word. I do not think it means what they think it means…

Permanent repeal of the flawed Medicare payment formula known as the Sustainable Growth Rate just got a lot more expensive….

via Doc Fix Just Got More Expensive – Margot Sanger-Katz – NationalJournal.com.

With explanatory graphics! The Sources of the SGR “Hole” — NEJM

This article and its graph (from the NEJM), and its interesting, informative but probably useless graph, was referenced today on twitter, via the Washington Post’s Wonkblog,

Recently, the Centers for Medicaid and Medicare Services announced a scheduled cut in Medicare physician fees of 27.4% for 2012. This cut stems from the sustainable growth rate (SGR) formula used by the physician-payment system. …
To illustrate the level of inequity in this system, we broke down the national spending for Medicare physician services by state and by specialty and determined which states and specialties have contributed most to the SGR deficit between 2002, when the program was last balanced, and 2009. Although SGR spending targets are set on a national level, we computed state targets by applying the SGR’s national target growth rate to each state’s per capita expenditure, using 2002 as the base year. Our analysis is an approximation, because, unlike the SGR, we do not adjust for differential fee changes. …

We compared the state targets for the years 2003 to 2009 to actual state expenditures and added the annual difference between these figures to get a cumulative difference between the state’s spending and the SGR target. This cumulative difference was then divided by the 2002 per capita expenditure to determine the percentage growth since 2002.

via The Sources of the SGR “Hole” — NEJM.

Here are the graphs, and my attempts at explanation, and the questions I have:  [Read more...]

HHS Audits the 1% … and the Rest: First HIPAA Privacy and Security Audits Begin – Davis Wright Tremaine

As the original twitterer ( @NickGenes ) said, “…because there wasn’t enough bureaucracy & expense in healthcare yet”.

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has begun the process of notifying covered entities that they are among the unlucky few who have been selected for the first Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy and security audits under the Health Information Technology for Economic and Clinical Health (HITECH) Act. …

While the first twenty covered entities have been selected, approximately another 130 remain in this audit round. HHS has indicated that it hopes to continue with proactive audits in the future and expects to become more aggressive in its enforcement of complaints.

via HHS Audits the 1% … and the Rest: First HIPAA Privacy and Security Audits Begin – Davis Wright Tremaine.

Yes, this is HITECH, the Son of HIPAA, but it all started with HIPAA.

Is it worth pointing out that HIPAA exempted itself from the unfunded mandate and paperwork reduction rules when it was enacted? I pointed out then that their assertion that it wouldn’t cause an increase in paperwork, nor was it an unfunded mandate was really unlikely.

How many Millions of dollars and man-hours are we pouring down these regulatory holes?