David Williams
My friend, Jordan Rau at Kaiser Health News reports that Medicare is upgrading its doctor ratings website, Physician Compare to get ready to provide more robust information as part of the Affordable Care Act. The site is intended to include more information about doctor quality and patient experience. It also has the capability to let patients search for doctors by part of the body, e.g., abdomen.
The fiscally reckless Medicare Part D drug benefit - passed by a Republican Congress and signed by a Republican President - continues to add to the US federal deficit and debt. I'm resigned to this program's continuation but perhaps there is hope for it to be modified or somehow brought into better balance.
The Affordable Care Act (aka Obamacare) is a complex, multi-faceted law but critiques of it are often simplistic and opponents find themselves getting twisted up in contradictions trying to resist implementation.
Bob Berenson, Harlan Krumholz and Peter Pronovost are luminaries in the creation of quality and safety measurements in health care. They have come together to propose Seven Policy Recommendations to Improve Quality Measurement, published on the Health Affairs blog. They propose a number of thought-provoking ideas but I find myself disagreeing with more of them than I would have expected.
I'd like to read the articles in JAMA Internal Medicine about shared decision making, but am too cheap to pay for access. So I'll rely on the LA Times article on the topic to make a brief comment.
My perception is that doctors in previous generations were more likely to devote their entire lives (professional and "personal" time) to the practice of medicine.
Generic drugs have been an effective cost containment solution for traditional, small molecule pharmaceuticals. As large molecule biologics proliferate and take up a growing share of medical spending, we also increasingly need cost containment.
Conventional wisdom is that cutting Medicare rates shifts the burden to the private sector, but an intriguing article in Health Affairs reaches a counterintuitive conclusion.
It's hard for policy wonks, politicians or health plans to be viewed credibly when promoting health care cost containment. Discussion quickly turns to "rationing," and "death panels," which no one wants to be associated with, and as a result the federal government has done almost everything possible to make sure cost effectiveness and overall costs are ignored in policy making.
Pharmaceutical Benefits Manager (PBM) Express Scripts released a report claiming that more than $400B in annual pharmacy expenditures are wasted and that the greatest waste occurs in the poorest states, i.e., the South. The map is pretty striking with the North the best, middle next, and South the worst.