Sunday, June 03, 2012

MSM: Will A Real Journalist Please Stand Up?

“There is some good news about the overly costly, underperforming health care system.”

So begins today’s New York Times editorial entitled “Treating You Better for Less.”  After reading the shallow piece, it hard not to stand in awe of their limited perspective and understanding of the complexity of reining in health care costs in America.

But these are the promoters of “experiments” to save money in health care:

“It is a measure of how dysfunctional the system has become that these successful experiments – based on medical sense, sound research and efficiencies – seem so revolutionary.”

What is dysfunctional is the administrative and third-party overhead in health care today.  One only has to look at the examples given in the editorial to see what I mean.

The "editors" describe how Virginia Mason Medical Center in Seattle lowered their CT and MRI scans by 23-27 percent by forcing doctors to click through a “checklist of the medical circumstances needed to justify a costly imaging test.” What else did they do? They “sharply cut” the time needed to process insurance claims by “consolidating steps.” In other words, the hospital spent a ton of money on an EMR system that improved their collections and slowed doctors’ work flows. Fortunately, “Virginia Mason has been reporting margins of 4 to 5 percent.”

I'm seeing cost savings there, aren't you?

Which is exactly my point.  Patients are not seeing these "savings."  The system is.  Our costs (need I remind anyone who pays a health care premium) have continued to skyrocket year after year after year.

But it doesn’t stop there.  You see Virginia Mason has set up a screening program for their large corporate buddies Starbucks and Aetna to treat back pain. Imagine: “by finding ways to separate out the uncomplicated cases (can you say questionnaires and mid-levels) they figured that if they just send people to physical therapy rather than ordering MRI’s, they save everybody money!

Wow. Incredible.  Millions "saved" there, I'm sure.  Here's an idea, Starbucks: why not avoid the hospital system all together.  Send 'em to physical therapy yourself!  What's that you say?  You're worried about liability risks?  Oh, I see.  Yeah, I guess that IS expensive, isn't it.  But please, don't mention the need for libaility reform.

Even better: “Premier, Inc. an alliance of more than 2600 hospitals across the country has been testing ways to save money and improve care.” How have they done this? Well, the editorial claims they have “reduced unnecessary laboratory and screening tests” and “reduced labor costs by eliminating inefficient processes” by using “caseworkers and administrative assistants rather than nurses to call patients to remind them of appointment checkups.” Seems like another way to make sure people keep using the system to me. Tons of cost savings there! Seriously, how does an “alliance” of 2,600 hospitals save anything except lobbying costs on Capital Hill?

Even more egregious: “Premier reported in January that over a three year period, 157 of its hospitals in 31 states saved almost 25,000 lives and reduced health care spending by nearly $4.5 billion, roughly 12% of the total three-year cost of care at those hospitals.” Now I have to ask myself: what about the other 2,243 hospitals in Premier’s network? How’s their track record been? Might we be missing something?

It is increasingly difficult to find real, credible investigative reporting and objective commentary regarding health care “reform” in today’s main stream media (MSM) and scientific journals. The world of sound bites and spin in our rush to "save costs" have become more important than facts and data.

We are talking about health care in America. We are talking about the incredibly challenging task of reducing costs in health care while trying to maintain some modicum of quality in a system of self-serving interests that are much larger than those of the doctor and the patient. Jobs are at stake.

To me, cutting administrative overhead in our bloated health care system should supersede ANY efforts to claim we’re “saving” a paltry 25,000 lives by administrative fiats rather than altering the mano-a-mano health care given by real doctors and nurses who work tirelessly each day in America’s health care system. Believe me, they save many more than 25,000 lives each year across America.  But we'll never hear that story, will we?

I might start asking myself who wrote today’s lead editorial in the New York Times.

Because it sure as hell wasn’t a real journalist.*


* Premier health's press release.

For another, more enthusiastic endorsement of Premier's corportate efforts: see The Happy Hospitalist.


Dr. Josh Umbehr said...

Nicely done. thank you for pointint out the one-sidedness of some of these claims. No one talked about the costs of these systems, hassle factor to the medicall team, and negative effects to the patients.

Too often, the answer to red tape appears to be red tape.

I think we are addressing the heatlhcare costs more directly like you mentioned, cutting out administrative costs and much more to benefit the patient.

Our family practice does not take insurance and works on a membership model. $10-100/mo/pt based only on age for unlimited home/work/office/technology visits. No copays. All office procedures/tests are free inlcuding: laceration repair, biopsies, joint injections, minor surgeries, ekg, holter, spiro, dexa (GE idxa), audiometry, urinallysis, rapid streps, sleepview home OSA testing, medical laser treatments (aerolase), injectable toradol/zofran/phenergan.

By working directly with the labs, we get an 80-90% discount on all labs. CBC $2, CMP $4.50, LIPIDS $3, TSH $4, T3 $4, T4 $4, OB PANEL $40.....etc....

By dispensing wholesale medications directly to our patients, we can pass the savings directly to our patients. These are the same suppliers that pharmacies use so there's no difference in quality. We are often able to save our patients more $$ on medicines than they even spend with us on memberships.

Negoiated rates for about 75% discount on MRI, CT, dx ultrasound.

With all of these savings, we're able to help people change their insurane for a 50-75% savsings for families and businesses allke. One great exmample is a company of 30+ who went 12 months with us after saving 55% on their health insurance and filed ZERO claims with their health insurance. Now health ins is more like car insurance where you rarely use it and as such it becomes affordable.

I'd love to see what your thoughts are on a model like this.

thank you
josh, md

Anonymous said...

It is admirable that you read the NYT. That drivel ruins my weekends so I decided to read the WSJ instead. My favorite complaint by the bureaucrats is the 'lack of coordinated care' which has resulted in specialists fragmenting care resulting in higher costs. No one in the MSM is clever or cares enough to realize that the draconian cuts to primary care in-patient fees resulted in the fragmentation in the first place. The government keeps trying new reimbursement schemes to correct that problem that they caused.

Such is the essence of big government as the cliche says, the right hand doesn't know what the left hand is doing.

Anonymous said...

I hope you sent a copy of this to Arthur Brisbane, NYT's ombudsman. I'd love to see his defense.

Anonymous said...

The vast majority of articles published in trade magazines are written by PR firms, on behalf a company or trade organization. The mag gets essentially free content, does minimal editing and keeps its staff payroll at a minimum. Looks like the NYT is doing the same thing.
Meanwhile, it is the companies that do the healthcare administrator that have the large new buildings, good profit margins and are hiring even more administrators, and PR Firms, to "help keep healthcare costs down?"

Anonymous said...

A plague on everybodys house.

We didn't go from top dog in healthcare to #25 (or whatever the lastest study in whatever field reports) in healthcare starting with this administration.

These "discounts" that can be achieved are disgusting. So who gets the screwing when they are at full retail price?

What are the ethical? patient? concerns of Josh's business model when the docs sell (oh excuse me, "provide")the drugs and MRIs?

Why did my new primary care doc (salaried by hospital) insist I see a urologist (salaried - same hospital) for a simple UTI that cleared up with antibiotics, the same way it has for the other five or so UT infections I have had over the course of my long life?

It's lovely, but who decided that all hospital rooms are now private?

Where were all the docs when it came to the craziness of "death panels"? How about some Dr Wes blogs regarding end of life care?
Some reality based end of life care would save a TON of money.

Well I guess the good news is that healthcare issues have reached enough of a crisis that it merits an op-ed in the NYT however woefully short on in-depth reporting.

Hal Dall, MD said...

"over a three year period, 157 of its hospitals in 31 states saved almost 25,000 lives"

So, Premier's claims 157 hospitals saved ~8000 lives per year by these changes. The IOM report "TO Err is Human" estimated 44k to 98k excess deaths yearly in US hospitals ("

Is Premier admitting 157 of their hospitals were responsible for ~10% of those excess deaths???

R. Garth Kirkwood, MD said...

R. Garth Kirkwood, MD

The NYT editorial, "Treating You Better for Less," Equals Socialism.