tag:blogger.com,1999:blog-8512362.post8500940384839228982..comments2024-03-10T13:59:19.230-04:00Comments on xpostfactoid: My healthcare credo to dateAndrew Sprunghttp://www.blogger.com/profile/17601269968798865106noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-8512362.post-20676689320844655922016-04-12T21:33:54.765-04:002016-04-12T21:33:54.765-04:00Thanks as always for your forthrightness.
I do no...Thanks as always for your forthrightness.<br /><br />I do not agree with three items:<br /><br />#7 - Social determinants of health<br /><br />Vast sums are spent on dialysis and cancer and CHF and COPD for perfectly normal happy people who just live a hell of a long time.<br /><br />9. Narrow networks in some form will be with us even in an equitable single payer system.<br /><br />Let us say that an America single payer system set the price of bypass surgery at $20,000.<br /><br />Mayo Clinic or Cleveland Clinic wants to charge $40,000.<br /><br />The single payer system says, "We will not pay Mayo's charges/"<br /><br />That is in effect a narrow network.<br /><br /><br /><br />10. Balance billing<br /><br />Undisclosed balance billing is a monstrous testimony to medical greed, I agree with you there.<br /><br />But transparent price quotes are not an evil thing.<br />bob.hertzhttps://www.blogger.com/profile/09686373408419885558noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-81257192872939961822016-04-11T13:43:14.902-04:002016-04-11T13:43:14.902-04:00Thank you, Unknown. The ACA provides a raft of inc...Thank you, Unknown. The ACA provides a raft of incentives for physician groups and hospitals to provide "coordinated care" that have accelerated existing momentum for hospital mergers and hospital buy-ups of physician groups. Historically, hospital mergers have led to higher prices, and recent research points toward physicians charging more once they're acquired by hospitals or health systems.Andrew Sprunghttps://www.blogger.com/profile/17601269968798865106noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-33188190436929607812016-04-11T13:38:18.425-04:002016-04-11T13:38:18.425-04:00Collegial and friendly responses:
#6: Some incent...Collegial and friendly responses:<br /><br />#6: Some incentives in PQRS (Physician Quality Reporting System, the basis for CMS's incentive programs) for example, are process-oriented; some are patient safety measures, and some measure outcomes. Some complain on general principle about process measures because they *don't* require evidence of better outcomes, but I worry generally about outcomes measures -- like, say, the results of cataract or retinal detachment surgery or post-stroke treatment. Perhaps the condition of patients prior to treatment can be massaged. A frequent counterargument against "test results will be gamed" worries in all fields is that you have to measure, and do the best you can to guard against cheating or gaming, and that's true to a degree.<br /><br />#9: If pricing were more or less uniform, different plans/insurers could conceivably shape networks on the basis of quality, but that might boil down to just weeding out really subpar performers. I suspect hat at present, there's a lot of lip service to selecting for quality but it's 97% about price. <br /><br />#10 We didn't exactly design our system; a lot happened by accident, and a lot didn't happen because powerful lobbies prevented it. No other developed country exposes patients at an in-network hospital to balance billing by out-of-network providers at that hospital. We allow it because of the power of (mainly) physicians' groups and (secondarily) insurers, and because the tug-of-war between them is uncontrolled. That's dysfunctional in my book.<br /><br />#11: Agreed that LTC is another major mess, where your choices, if you're not destitute, are unreliable private insurance or a riks of spending down till Medicaid kicks in.Andrew Sprunghttps://www.blogger.com/profile/17601269968798865106noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-81239285428229321672016-04-11T09:54:58.073-04:002016-04-11T09:54:58.073-04:00I, too, would like you to clarify. I don't kn...I, too, would like you to clarify. I don't know what you mean by #2. I find your blog consistently useful.Anonymoushttps://www.blogger.com/profile/00745979543487319708noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-569563160635240502016-04-10T09:34:29.384-04:002016-04-10T09:34:29.384-04:00Collegial and friendly comments:
#6: What do you ...Collegial and friendly comments:<br /><br />#6: What do you mean by positive incentives?<br /><br />#9: Dysfunctional system? Narrow networks could be appropriate in a functional system. If your vision is one IDS per city/MSA, I get it. But not realistic I think--and using networks seems like a sensible strategy.<br /><br />#10: Deep dysfunction? We designed our system to get us the intended result. I dont see it as societal dysfunction.<br /><br />Add #11: Medicaid as all things to all people will accelerate its demise in current form. Unsolved LTC needs and underfunding cannot persist indefinitely.Brad Fhttps://www.blogger.com/profile/10366408815395434941noreply@blogger.com