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Scott Elliott is an editorial writer and columnist for the Dayton Daily News opinion pages. He writes about education, city and suburban issues, politics, business, workforce and consumer issues.Home > Blogs > A Matter of Opinion > Archives > 2010 > September > 21 > Entry
Guest column: Veteran innovator heads effort to reform Medicare
This commentary was written by Dr. Lawrence E. Mieczkowski, an internist who specializes in cardiovascular disease prevention. From 1994-96, he was director of clinical information services for Kettering Medical Center.
As the president’s new health care plan unfolds, covering the uninsured, improving the quality of care, and slowing the increase in health care costs all have to occur.
Two patient scenarios I recently encountered point to that need and the possibilities.
Bud is a 66-year-old guy with heart disease, high blood pressure, high cholesterol and pre-diabetes. His body is riddled with degenerative arthritis from hard physical work. One weekend, he noticed that his arthritic left shoulder was hurting him more than usual.
He had recently overexerted himself. When the shoulder and arm continued to ache, he went to the emergency room. Because he had a history of heart disease, the docs did a heart work-up, got the cardiologist involved, had the patient go through a heart catherization, and ordered MRIs and X-rays.
No one from the hospital called me, his doctor. When nothing new showed up, he was sent home and told to follow up with me.
I concluded the pain was from his arthritis. I asked why he didn’t call me before he went to the ER. He didn’t have an answer.
Medicare was billed. The patient’s cost: probably $100.
Linda, 58, reached me when I was on call for her doctor. She was having chest discomfort and feeling winded. She had called her insurance company’s “talk to a nurse” program. The RN advised she speak to her physician.
A year ago, Linda had been hospitalized with a blood clot to her lungs. She was apprehensive, worried that she had a recurrence of the blood clots. I listened to her complaints, but reassured her that her symptoms were most likely from allergies.
The additional cost to the health care system: No charge.
Clearly, there’s waste and overuse in our health care system. That’s guaranteed, considering that profits increase as more services are rendered.
A recent analysis of New York State Cardiac Services published in a major heart journal indicated that nearly 30 percent of clinically stable patients with heart disease were referred for bypass surgery or stent placement.
In a 2005 analysis of regional Medicare heart procedures, Elyria’s rates were more than three times higher than the procedure rate in neighboring Cleveland. This gross discrepancy resulted in fraud investigations of a major northern Ohio cardiology practice.
One initiative aimed at discouraging overuse of medicine is the National Priorities Partnership. It’s trying to change the mistaken public perception that spending more money correlates to better health care.
Among the problems it’s focusing on:
• Using the wrong medication runs up spending.
Newer blood pressure medicines that cost $50 per month are not really more effective than many generics. There is often marginal benefit from drugs for dementia, osteoporosis, psychotic states and infections.
• Unnecessary and duplicate lab tests waste billions.
Physicians routinely order panels of tests, despite multiple studies demonstrating limited value in predicting complications or risks.
• Inappropriate chemotherapy, blood transfusions and hospital stays for dying cancer patients are a major cost to Medicare.
Despite a wide awareness of the value of hospice care, spending on it has not paralleled the rise in chemotherapy costs for patients in their last 30 days of life.
• Orthopedic surgeries and hip/knee replacements are often unwarranted.
The billion-dollar question is how do we turn an inefficient, wasteful system into a high-quality, affordable, efficient one?
During the past 20 years, many health care systems have adopted ideas from the Institute for Healthcare Improvement. The IHI is a not-for-profit led by Dr. Donald Berwick. Intensive-care projects, stroke teams, and efforts to reduce hospital-acquired infections are just a few of the IHI initiatives.
We now have a chance to see these quality-management efforts embodied in Medicare and Medicaid under Berwick’s leadership. President Barack Obama recently appointed him to head the massive Medicare services organization.
The appointment rankled conservatives, who complain he favors rationing care. But to many involved in health care delivery, the appointment was a bold move to make a seasoned innovative leader the voice of Medicare health care reform.
The opportunities and challenges in front of us are many. I challenge local hospital leadership and physicians to take notice and join the effort.
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By joe_mamma
September 22, 2010 7:22 AM | Link to this
Here’s Donald Berwick in his own words advocating Government run healthcare… http://www.youtube.com/watch?v=r2Kevz_9lsw
By Max
September 22, 2010 10:38 AM | Link to this
Medicare has been a national ‘taffy pull’ since its creation. It has undergone scrutiny due to billing corruption, adminstrative inconsistency in approved diagnostics and treatment, funding, and so forth. Then, outside Medicare, the doctors have responded to increased malpractice suits by over treating to cover their rear ends. Then, malpractice caps were proposed, and so on and so on. Whether or Medicare was designed as sole healthcare insurance, there was a time when people retired with private healthcare and Medicare being the secondary insurer. Now, as the good doctor says we are in another phase of healthcare reform. His examples of how costs can be lowered with improved care levels are certainly the high and low points of the system as it exists today. When we speak of government run healthcare we are already in trouble; through DOD hospitals, VA medical facilities, and contracted HMO’s such as Tricare are considered government ‘run’ healthcare entities. The interesting part of this is those facilities and systems refer patients - due to overload, specialities, cost, etc. - to the same hospitals Medicare is accepted with the notable difference; Medicare seems to pay more most of the time. This would suggest it isn’t ‘government run’ healthcare that’s the problem but one major facet and its management is. How does one reform that? As Dr. Mieczkowski ambitiously states, level of care plus reducing costs presumes reform will address both goals. Perhaps, but it hasn’t thus far and as industry reduces or eliminates HC benefits the demand for Medicare will be greater not less. The two ER examples Dr. M. offers, I am sure, happen daily across the nation. But, are those the anomolies or business as usual? Is that enough to merit reform which is hostage to a fixed amount of resources? I would agree Obama has gone way over the top in his army of ‘czars’ to address these issues of national importance and, thusly, is a way of dealing with an issue Congress hasn’t the political will to confront in their bugetary meetings. The Republicans’ argument against reform, however, is speculative and fear based. Quality of care is managed at the primary care provider/hospital level, not the government; again, leave business alone.
By Max
September 22, 2010 11:11 AM | Link to this
Joe, pick your Czar……they are just another group of people assigned to ‘talk’ when we need leadership. Even the Fed’s last statement - press release - was a waste of an otherwise adequate language. The Dem’s want reform but have no direction to take it. The Rep’s want to use fear to control the senior vote. As, so we have it, another day in the Republic’s decline. (My empathy goes to future historians who write about this age; even they will be bored senseless.)