April 24, 2011
Sometimes I read something that makes me scratch my head and say, “Duh!” Today, I was catching up on my reading when I came across an article in the AMA NEWS entitled, “Costliest hospitals report lowest death rate”. This revelation did not surprise me in the least. After all, you get what you pay for, don’t you?
The study, published in the prestigious Annals of Internal Medicine found, “California hospitals that spent more had lower in-hospital mortality rates for Medicare patients with six common deadly conditions such as congestive heart failure and pneumonia.” Having worked in the slums of New York and the Ritz of Barrington, Illinois, I can assure you that patient care differs depending on the capabilities of the hospital you are admitted to.
It takes money to equip and maintain a hospital with the latest and greatest diagnostic, therapeutic and surgical tools. Technology is constantly changing. Today’s super fast CT scanner is tomorrow’s junk. High tech facilities draw gifted physicians. The end result is that the cost of care goes up and the ability to rescue patients from the throes of death improves. Again, duh!
Every day of the week, I see miracles. My mother, at the age of 88, got two new heart valves. At the age of 89, she is actively involved with life. My hospital’s state of the art cardiovascular surgical center played a major role in returning her to good health. My 59 year old patient with prostate cancer had a robotic (DiVinci) assisted radical prostatectomy and went home in two days. In the past, it would have been a week or more. Now, he is able to control his urination; in the past he would have been incontinent. My patient with a sick gallbladder had it removed through a scope and went home in 23 hours and back to work in three days. In the not too distant past he would have suffered for 6-8 weeks. These advances cost money and are found in the more expensive medical centers.
What scares me is that Congress, the insurance companies and the public are all demanding that the cost of medical care be controlled! Every year, our government cuts expenditures on Medicare. Research grants are drying up. The cost of medical care has become a scapegoat for all that ails society.
So, what is going to happen to your care as government funds diminish and insurance companies continue to cut reimbursement for services as they post ever increasing profits? You get what you pay for, right? I’m very much afraid that what is going to happen is that the progress I have witnessed over the last ten years is going to disappear.
Do I sound paranoid? I’m not! The majority of the medications I prescribed this week were introduced in the 90s. There is a strong push to prescribe generic medications. Generics are prescribed because they are cheap, not because they are better. Access to more modern, branded medication is being limited by insurers so that they can continue to post record profits. Insurers now financially penalize docs who don’t meet a “prescribed generic” quota.
Access to the latest MRIs, CT Scans, Nuclear Stress Tests and other high end diagnostic procedures are also being limited (see article on prior authorization, April 15, 2011). As access is denied, fewer tests are being done. As the volume of tests being done decreases, the ability to afford to buy and maintain the newest equipment decreases. It is the proverbial snowball effect.
So, what is the answer? Regress? I cared for my patients during the 90s; and for the most part, they did well. I certainly can do it again. So what if the patient takes longer to recover. Ration care? To most people’s surprise, care is rationed now. Every year, I have to jump through more difficult hoops to get my patients the care they need. I suspect that rationing in the form of ACOs/HMOs will be the next big hurdle. Medicare recipients will be herded into ACOs/HMOs in 2015. As the ACO story develops, I will keep you informed.
Pay for what you get? Yes, you will. The study quoted at the beginning of this article suggests that the more you pay the better your chance of survival is. What is your life worth? What are the lives of your spouse and children worth?