Thursday, April 30, 2009

Medicare Reform Will Raise Physician Howls!

I am flattered that influential U.S. senators must be reading MDWhistleblower for important policy advice. Senator Max Baucus, Democrat of Montana, and Charles Grassley, Republican of Iowa issued proposals that aim to change the Medicare payment system to doctors and hospitals. Payment would be directly linked to quality, rather than to volume of services. Under the present system, if a surgeon operates on a patient 3 times to correct his own complications, he is paid more than a colleague who got it right the first time. However, as discussed in many prior postings on this blog, medical quality is very difficult to measure.

One of the senators’ specific proposals receives a 5 Star Whistleblower Award for medical quality. The government will aim to reduce the excessive use of CAT scans, MRIs and other advanced medical imaging techniques that cost a fortune and create unnecessary medical cascades that chase after trivial lesions that will never cause illness. (Click here for a related rant. ) While I am reluctant for the government to be the one establishing the national radiography standards, as the senators propose, I endorse the concept enthusiastically. If physicians were smarter, we would be devising quality standards ourselves before the government and insurance companies do so in the near future.

One of the failings of the medical profession is that whenever there was a need for reform, we remained passive. Then, after the ‘reformers’ and bureaucrats stormed in and attacked the problem we ignored, we physicians howled in protest. This time, a medical reform tsunami is approaching and most doctors will drown in denial. Do you have a good pair of earplugs? You will need them because there will soon be ear piercing howling from hamlets, towns and cities across America.


  1. Too true. Lack of accountability has left a giant gap for regulators to drive through and wreak havoc on the 'profession'. Health care is a house of cards which will come crashing down when people realize how little the economy needs health care. Most primary care doctors tell me that 1/3 to 1/2 of visits are not needed. Dangerous, inefficient polypharmacy is the rule. I used to stop lipitor in at least one 20-30 year new patient old every week, showing them the risk calculation from Framingham. And a lot of doctors are still insisting that the pharm marketing 'has no influence on my prescribing' Ha!

  2. Thanks for your comment. I think there is a distinction between "how little the economy needs health care" and the excessive amount of medicine being practiced. While medicine is a financial drain, it does contribute enormously to the economy in medical care, research, biomedical engineering, biotechnology, etc.

  3. "The government will aim to reduce the excessive use of CAT scans, MRIs and other advanced medical imaging techniques that cost a fortune and create unnecessary medical cascades ..."

    Great but how will they change the medical liability issues that drive this problem??

    In New Zealand, where the ambulance chasers don't exist FAR fewer 'advanced imaging' studies are carried out through ER visits. Tort reform First! There are other drivers, but ...

  4. The Nw Zealand concept won't take off here in the U.S. The idea makes too much sense.

  5. I couldn't agree more with your comment here or your recent post on the WSJ blog.

    My one addition would be to note that all major changes need to be systemic. For example, if doctors currently reduce MRI's how legally exposed are they in the .001% of the cases where it really would have found an underlying problem. Even more critical is the patient who often demand every test, not every doctor is able to push back each and every time.

    Health care is a very intertwined ecosystem - most often the only way to change one part is to concurrently have to change several, which is why its so damn hard

  6. Dr. Kirsch, You are doing your part. Hopefully other doctors realize the need asap. Otherwise, if many issues are not addressed and acted on from within what is to be expected other than the outside blundering in, out of necessity.

    People out here notice and appreciate a valiant attempt.


  7. Thanks Patricia. Unfortunately, the physician community is divided on many issues. This reduces our influence in the health care reform process. As you point out, when a group doesn't reform itself, then others will step in and do it for them.