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In previous blogs we have spelled out some of the contradictions and deficiencies inherent to the ACA/CMS campaign to improve medical quality and value. Clearly something needs to change in health care, which is why these reforms are being instituted. Both financial value and medical quality are poor across the country, as insurance continues to pay more for hospitalization and high-cost tests/procedures than for home care and prevention; health outcomes have fallen far behind the huge expenditures that are often causing more harm than good; and both doctors and patients are frustrated. We have discussed how many ACA and CMS programs are very likely to fail, and at best will make a minor
Imagine you are sitting in a 1000 seat theater filled with former or current heavy smokers, and you are told that Medicare will now pay for a test that, if done every year for 5 years on everyone in the theater, will save 3 people in the theater from dying of lung cancer. Would it be worth it? What if you were then told that two-thirds of people informed that they may have lung cancer with the test actually don’t have lung cancer, and it will require further testing, some of it harmful and life threatening, to prove that they don’t actually have lung cancer? In fact, while 3 lives are saved from lung cancer in the theater, 6 people without lung cancer will suffer significant harm from the
Since the ACA plans to pay physicians based on quality and value, it is vital that we determine how these terms are defined and measured. We have already discussed that the ACA’s conception of quality, demonstrated by proving adherence to Medicare’s quality indicators and the “meaningful use” of electronic medical records (EMR), verges far from genuine geriatric quality care, and often even leads to poor quality. More significantly, doctors squander valuable time having to prove their compliance with quality indicators and EMR requirements, time that could otherwise be spent discussing important issues with their patients and contending with their patients’ chronic illnesses comprehensivel
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