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The fiscal future of weight management

Douglas W. Rothrock, M.D., the  founder of Prescott Cardiology, in Arizona, looks at the intersection of value-based payments, MACRA and the obesity epidemic in a Physicians Practice piece, at the end of which he comments:

“By offering a weight management protocol that is consistent with evidence-based guidelines, physicians can help patients prevent disease progression, improve standards of quality in obesity management, and comply with an achievable quality measure that can contribute to maximum reimbursement.

“In the future, we may expect to see the astronomical human and fiscal cost of obesity prompts the expansion of quality measures for obese patients, including evidence-based obesity prevention and treatment that includes the behavioral, nutritional intervention, and counseling necessary to lose weight and keep it off. And at the heart of MACRA and other value-based payment systems, that’s what it’s all about.”

To read his essay, please hit this link.

Douglas W. Rothrock, MD is the founder of Prescott Cardiology in Arizona.

Wasteful, greed-driven U.S. health system makes costs far higher than in Canada’s

In another part of his Med Page Today series on how  and why Canadian and U.S. healthcare are so different, Michael Smith  looks at how the economic players drive up costs in the United States to maximize profit.

He notes:

  • “In 2014, according to the Organization for Economic Co-operation and Development(OECD), U.S. healthcare accounted for 17.1% of GDP — the highest by far among ranked nations — and about half of that was public money.
  • “In the same analysis, Canada spent about 10.4% of GDP, with slightly more than 70% coming from public sources.
  • “On a per capita basis the figures were $9,403 in the U.S. and $5,292 in Canada — both expressed in U.S. dollars.” {And Canadian costs are higher than Western Europe’s}

He refers to the observations of David Belk, M.D.:

On his Web site, “True Cost of Healthcare,” he catalogues where the money goes: drug companies set high prices for drugs, pharmacies overcharge, pharmacy benefit managers take a chunk of medication co-pays, and hospitals and doctors over bill in order to ensure that insurance companies pay them enough.

“But at the bottom, it is insurance that drives the engine of U.S. healthcare, Belk argues: ‘The health insurance companies bear most of the blame for why healthcare is so overpriced in the U.S.. They control most of the money that goes into healthcare and directly benefit from all of the obscurity and waste that exists in our system.”‘

 To read the piece, please this link.


Partners CEO discusses possible GOP health bill impacts

Video: See this New England Council interview with David Torchiana, M.D., president and CEO of Partners HealthCare, the biggest hospital system in New England, on the possible impact of Republican health-insurance legislation on, among other things, the Bay State. To see the video, please hit this link.

Population-health programs vs. hospitals


Eric Hunter, CEO of safety-net health plan CareOregon, said that if its population-health efforts were as successful as he’d like, hospitals would significantly cut back on their services.

“I tell hospitals, and they hate when I tell them this, ‘In my perfect world, I would never need you,’” Mr. Hunter told panelists at a Politico event. “My goal is to put you out of business. If we can do the right thing, all you’ll have is an ER for when somebody gets in a car wreck.”

But many  providers won’t have  access to strong community health programs such as CareOregon’s.

Karen DeSalvo, M.D., former national coordinator for health information technology at the the Department of Health and Human Services, pressed for culture changes that include breaking down data silos that block providers from seeing the full picture of a patient’s, or a  community’s, health.

Dr. DeSalvo said: “It means that we really have to rethink how we look at health.”

To see the Politico event, please hit this link.


FTC acts to stop Sanford’s takeover of N.D. physician group


The Federal Trade Commission, worried about less competition and resulting higher consumer prices, has acted to stop a large rural nonprofit healthcare system from acquiring a big North Dakota physician group.

The agency and the state attorney general have filed a complaint  in federal district court seeking a temporary restraining order and preliminary injunction to stop the deal between Sanford Health and Mid Dakota Clinic pending an administrative trial,   scheduled to begin on Nov. 28.

The takeover would create a physician group with at least 75 percent share of primary care and several other healthcare services in its market.

The FTC said the deal would violate antitrust law by significantly  cutting competition for adult primary-care physician services, pediatric services, obstetrics and gynecology services, and general surgery physician services in the greater Bismarck and Mandan metropolitan area.

Sanford Health is the largest, rural, not-for-profit healthcare system in the country, with among other facilities,  45 hospitals and 289 clinics in nine states and three countries. Mid-Dakota has over 90 clinicians.

The FTC asserts that the deal that it would be the only physician group offering general surgery physician services in the affected area.

“This merger is likely to reduce significantly the competitive options available to medical insurance providers, which in turn will lead to deteriorating terms for provision of medical care, including higher prices and lower quality,” said Tad Lipsky, acting director of the FTC’s Bureau of Competition.

Sanford Health and Mid Dakota Clinic currently compete to join commercial insurers’ provider networks, which Lipsky said spurs the organizations to improve their technology, expand services, recruit high-quality physicians and provide patients with convenient and accessible physician and surgical services. “The transaction would eliminate that competitive pressure,” he said.

But the two healthcare organizations told The Bismarck Tribune that the FTC’s actions are “extremely frustrating” because they relied on national, legal and economic experts to evaluate the partnership.

“The best way to describe our reaction is that we are exasperated with the delay that the FTC’s inquiry has already caused and that these proceedings will continue to cause,” Shelly Seifert, M.D., board chair of the Mid Dakota Clinic, told  the newspaper.

To read more, please hit this link and this one.

Providers denounce Senate GOP leaders’ healthcare bill


Leaders of the hospital sector and other major healthcare groups have denounced the Senate Republican leadership’s  Affordable Care Act repeal bill as  little or no improvement over the House bill, which  providers have criticized as imperiling the health of millions of patients.

Rick Pollack, president and CEO of the American Hospital Association, said of the”Better Care Reconciliation Act of 2017”:

“Unfortunately, the draft bill under discussion in the Senate moves in the opposite direction {from protecting coverage}, particularly for our most vulnerable patients. We urge the Senate to go back to the drawing board and develop legislation that continues to provide coverage to all Americans who currently have it.”

Bruce Siegel, M.D., president and CEO of America’s Essential Hospitals, said: “For the hospitals that protect millions of Americans and their communities—our essential hospitals—this bill might even accelerate decisions by some to reduce services or close their doors.”

“The Senate healthcare bill released today is just as bad as the version passed by the House of Representatives last month and is a threat to the health of America,” said George Benjamin, M.D., executive director of the American Public Health Association. He asserted that  Senate Republicans had committed “legislative malpractice.”

David O. Barbe, M.D., president of the American Medical Association, chimed in with:

“The AMA is reviewing the Senate health system reform legislation, guided by our key objectives that people who are currently insured should not lose their coverage and that Medicaid, CHIP and other safety-net programs should be adequately funded. The AMA strongly opposes Medicaid spending caps, and we have grave concern with a formula that will not cover needed care for vulnerable patients.”

And  Bernard J. Tyson, chairman and CEO of Kaiser Permanente, said:  “First, we need to cover more people, not fewer people.” He suggested   a three-part test to determine what healthcare progress ought to look like: Does it achieve wider  access, affordability and better outcomes?

Centers for Medicare & Medicaid Administrator Seema Verma, a Trump appointee, not surprisingly, praised the bill.

“I appreciate the work of the Senate as they continue to make progress fixing the crisis in healthcare that has resulted from Obamacare. Skyrocketing premiums, rising costs and fewer choices have caused too many Americans to drop their insurance coverage. Today, Obamacare is in a death spiral and millions of Americans are being negatively impacted as a result. They are trapped by mandates that force them to purchase insurance they don’t want and can’t afford.” {The term “Obamacare” is usually used by Republicans as a derogatory term for the Affordable Care Act, the law’s official name.}

“The Senate proposal is built on putting patients first and in charge of their healthcare decisions, bringing down the cost of coverage and expanding choices. Congress must act now to achieve the president’s goal to make sure all Americans have access to quality, affordable coverage.”


CMS further lightens the MACRA load.



CMS is continuing to lighten the MACRA load after smaller and rural providers  complained that their paucity of capital and other resources make complying with the reporting requirements too difficult.

Its latest proposed move would permit  the exemption of small providers participating in the program by increasing the low-volume threshold to $90,000 or less in Medicare Part B charges or 200 or fewer Medicare patients annually. The original threshold was $30,000 in Medicare Part B charges or 100 Medicare patients. The agency believes  that the move would let about 134,000 clinicians stay out of  MIPS.

The proposal follows more than 800,000 clinicians in May being told that  they will not be evaluated under the MIPS program

MACRA will replace Medicare’s Sustainable Growth Formula with a 0.5% annual rate increase through 2019. After that, CMS says, physicians are encouraged to shift to one of two Quality Payment Programs: 1) Merit-Based Incentive Payment System (MIPS) or 2): Alternative Payment Model (APM).

Most physicians are expected to enter the MIPS.

“We’ve heard the concerns that too many quality programs, technology requirements and measures get between the doctor and the patient,” said CMS Administrator Seema Verma. “That’s why we’re taking a hard look at reducing burdens. By proposing this rule, we aim to improve Medicare by helping doctors and clinicians concentrate on caring for their patients rather than filling out paperwork. CMS will continue to listen and take actionable steps toward alleviating burdens and improving health outcomes for all Americans that we serve.”

American Medical Association President David Barbe, M.D., praised  CMS.   “Not all physicians and their practices were ready to make the leap, and many faced daunting challenges. This flexible approach will give physicians more options to participate in MACRA and takes into consideration the diversity of medical practices throughout the country.”

To read more, please hit this link.

Video: Should medical school be cut to three years?


Arthur L. Caplan, Ph.D., the medical ethicist, discusses in this Medscape video and text with  Steven B. Abramson, M.D., and Stanley Goldfarb, M.D., whether medical school should be three years instead of four.

Dr. Caplan concludes:

“What is my takeaway from this interesting discussion? I think major curriculum change is in the air, and we are going to see more of it. It is likely that more schools will experiment with a 3-year curriculum. It is not for everyone. As our guests pointed out, not everybody is going to flourish in a 3-year curriculum. There will certainly be schools that do 4 years, and maybe longer periods of training.

“At the end of the day, the 3-year curriculum is not really the solution to the high cost of medical education. If we are going to fix that problem, it will have to come through government subsidy, philanthropy, gifts, and other solutions.

“The 3-year curriculum is not the answer. It is the answer for some students who know what they want to be and know what specialty they want to enter. They can get there faster and move more quickly down the road of training by having that option.”

To read and watch the discussion, please hit this link.

Lahey Hospital CEO leaving to head Dartmouth-Hitchcock

Dartmouth-Hitchcock Medical Center, in Lebanon, N.H.

The chief executive of the prestigious Lahey Hospital & Medical Center, in Burlington, Mass., is leaving to lead New Hampshire’s largest health system.

Dartmouth-Hitchcock Health System, based in  Lebanon, N.H., said  that Joanne Mather Conroy, M.D., would become CEO on Aug. 7. Dartmouth-Hitchcock is associated with the Geisel School of Medicine at Dartmouth College. Its flagship is Dartmouth-Hitchcock Medical Center, New Hampshire’s only academic medical center,

Dr. Conroy has only headed  Lahey Hospital since July 2014.  Her exit after such a short time may suggest that she wasn’t happy there. The hospital is the flagship of Lahey Health, a Greater Boston system whose CEO is Howard Grant, M.D. He’ll  take on the dual role of being CEO for the Burlington hospital, too. He’s had that dual role before.

To read more, please hit this link.

Greed linked to healthcare ‘corporatization’ said to ravage America

“Avarice,” by Jesus Solana.

Vikas Saini, M.D., president of the Lown Institute, and Shannon Brownlee, the healthcare reform organization’s vice president, discuss in the Huffington the massive, greed-fueled corruption in U.S. healthcare that drives up costs to astronomical levels and ravages the economy.

They write:”

“Our health care system is no longer about relieving the suffering of patients… It’s about making money.
“Why? Because our increasingly corporatized healthcare system is driven by an insatiable appetite for profit. Our healthcare system is no longer about relieving the suffering of patients or the intrinsic value of maintaining the health of our population. It’s about making money: for pharmaceutical companies, device manufacturers, hospitals, insurance companies, and increasingly, for doctors. And all of these players are gaming the system and hurting patients in the process.”

“Healthcare spending consumes one-fifth of GDP. While health care does create jobs, it also takes jobs away by reducing spending for other public goods: housing, education, and infrastructure. Healthcare costs bankrupt patients, choke small businesses, contribute to stagnate wages, and force governments at all levels to trim public services.”

To read the piece, please hit this link.

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