New study: Tort reform has not reduced health care costs in Texas

Medicare spending up

The researchers assumed that doctors who faced a higher risk of being sued — those in counties that had larger numbers of malpractice cases — would perform more tests and procedures than necessary to protect themselves from lawsuits. With tort reform, which limited damage awards against doctors, the need to practice such “defensive medicine” would decline, the argument goes.

But in comparing Texas counties in which doctors faced a higher risk of lawsuits with counties where the risk was lower, the researchers found no difference in Medicare spending after tort reform and indications that doctors in higher- risk counties did slightly more procedures.

“If tort reform reduces spending, it would have the biggest effect on high-risk counties,” Silver said. He noted that those tend to be large and urban.

“This is not a result we expected,” said Bernard Black, a co-author and a professor at Northwestern University’s Law School and Kellogg School of Management.

Health care spending has increased annually everywhere, the researchers said, including in the states with caps on malpractice payouts — now at 30, counting Texas, said David Hyman, a co-author and professor of law and medicine at the University of Illinois.

But, said Hyman, who worked on health policy for President George W. Bush at the Federal Trade Commission, “we found no evidence that Texas spending went up slower in comparison to all other states and may have had an increase.”

The researchers said their study suggests that Medicare payments to doctors in Texas rose 1 to 2 percent faster than the rest of the country, Black said.

Since tort reform, some Texas residents have complained that they cannot find a lawyer to pursue a malpractice case because of the $750,000 cap on payouts for pain, suffering, disfigurement and mental anguish. The limit often makes litigation cost prohibitive, patients and lawyers said. That concern was not raised in the paper, although the researchers said claims of huge malpractice payouts and rampant “frivolous” lawsuits before tort reform are greatly exaggerated by its advocates.

Silver said he was “very pessimistic” that policymakers will heed the study. “The rhetoric on both sides tends to be very extreme,” he said.

Professionalism, the Invisible Hand, and a Necessary Reconfi… : Academic Medicine

Our third duty in the Charter on Medical Professionalism is to be good stewards of resources. This brief article makes the case for explicit and detailed education for medical students on this critical aspect of health care.

The first two months of medical school (with preexisting courses taxed to create this curricular space) will be devoted to the economics of care. This block will involve multiple pedagogical approaches from traditional didactics and problem-based learning to simulation and social networking. Instructors will range from topic experts to patients and members of the public whose lives are being bludgeoned by health costs. Preceptorships will be community based and will focus on student experiences in educating the public on the cost of both schooling and health care. Once this competency is mastered, students will begin to meet with patients upon discharge (clinic or hospital) to explain all charges. There will be no traditional “patient care” contact until students are fully able to decode and explain the highly cryptic billing statements that encumber patients. As students enter the biomedical side of their training, patient meetings will begin to add explanations of diagnoses and treatment options to those of cost. No student will be admitted to the care side of the educational continuum until he or she is fully able to explain to patients what has been done to them and why. As students move into residency training, they periodically will be shifted from their clinical responsibilities into the discharge process to recheck on their decoding and explaining competencies. National boards will reflect this new mandate. So, too, will CME requirements, which will include mandatory credits in cost competency. Cost will be defined as a major burden of treatment, with “burden of treatment” a major reframing of how we conceptualize and approach health care.³

We seek to provide a system of training that will produce true patient-centered practitioners, a bona fide revolution in what it means to practice medicine, a physician workforce prepared to lead, and a true profession willing and able to regulate itself on behalf of the public.

Commentary: Affordable Care Act a life-saver for ‘Susan.’ | www.palmbeachpost.com

DFA’s Dawn Harris Sherling, M.D, illustrates the very real consequences of life with and without health care access…

As the court debates forcing people to buy broccoli and other theoretical legal nonsense, I worry about my very real patients. Unlike the supermarket, very few of us willingly enter the health care marketplace. One day, when we least expect it, we will be flung into it by cancer, heart disease, infection or an accident. We may have led lives to encourage it. We may have done nothing except to have very bad luck. And we can only hope that, unlike Susan, when we are at our lowest the last thing we will have to worry about will be our health insurance.

Small Business Majority | Small Business Owners’ Views on Implementing the Affordable Care Act

Key findings:

Only a third of small business owners want the Supreme Court to overturn the Affordable Care Act; a plurality of 50% would like it upheld, with minor or no changes. This support grows after learning more details about the law’s key provisions:
Only 34% of small businesses want to see the healthcare law overturned, while 50% want it to remain intact with, at most, minor changes. After learning more about its specifics, only 28% want to see it repealed and a 56% majority want it to be kept, as is or with minor changes. A 55% majority say they want it upheld because we need to make sure everyone has health coverage.

Figure 1: After learning about the law, support for the Affordable Care Act grows

There has been a lot of talk about the nation’s health care reform law, the Patient Protection and Affordable Care Act. Which one of the following statements comes closest to your point of view when it comes to this law.

After everything you read, which one of the following statements comes closest to your point of view when it comes to the nation’s healthcare reform law, the Patient Protection and Affordable Care Act.

By an 8:1 margin, entrepreneurs say they’d consider using a state health insurance exchange, and they favorably view many possible features of the exchange:
A 66% majority of small business owners say they would use their state exchange or at least consider using it, compared to 8% who say they would not consider using it when they provide benefits. By wide margins, entrepreneurs find a host of possible features of the exchange very appealing. By a 2:1 ratio, small business owners support their state applying for federal funds to set one up.

Navigating the Labyrinth of Medical Costs – Your Money – NYTimes.com

Hospital care tends to be the most confounding, and experts say the charges you see on your bill are usually completely unrelated to the cost of providing the services (at hospitals, these list prices are called the “charge master file”). “The charges have no rhyme or reason at all,” Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins Bloomberg School of Public Health. “Why is 30 minutes in the operating room $2,000 and not $1,500? There is absolutely no basis for setting that charge. It is not based upon the cost, and it’s not based upon the market forces, other than the whim of the C.F.O. of the hospital.”

And those charges don’t really have any connection to what a hospital or medical provider will accept for payment, either. “If you line up five patients in their beds and they all have gall bladders removed and they get the same exact medication and services, if they have insurance or if they don’t have insurance, the hospital will get five different reimbursements, and none of it is based on cost,” said Holly Wallack, a medical billing advocate in Miami Beach. “The insurers negotiate a different rate, and if you are uninsured, underinsured or out of network, you are asked to pay full fare.”

With the exception of Medicare and Medicaid, experts say, the amount paid for services — or the price your insurers pay — is based on the market power of the insurance company on the one side and the hospitals and providers on the other, and the reimbursement agreements they ultimately reach. So large insurers that command a lot of market power may be able to negotiate lower rates than smaller companies with less influence. Or, insurers can place hospitals or providers on a preferred list, which may help bolster their business, in exchange for a lower reimbursement rate. On the other hand, well-regarded hospitals may command higher prices from insurers.

George Lakoff: The Wisconsin Blues

Scott Walker was just carrying out general conservative moral policies, taking the next step along a well-worn path.
What progressives need to do is clear. To people who have mixed values — partly progressive, partly conservative — talk progressive values in progressive language, thus strengthening progressive moral views in their brains. Never move to the right thinking you’ll get more cooperation that way.
Start telling deep truths out loud all day every day: Democracy is about citizens caring about each other. The Public is necessary for The Private. Pensions are delayed earnings for work already done; eliminating them is theft. Unions protect workers from corporate exploitation — low salaries, no job security, managerial threats, and inhumane working conditions. Public schools are essential to opportunity, and not just financially: they provide the opportunity to make the most of students’ skills and interests. They are also essential to democracy, since democracy requires an educated citizenry at large, as well as trained professionals in every community. Without education of the public, there can be no freedom.
At issue is the future of progressive morality, democracy, freedom, and every aspect of the Public — and hence the viability of private life and private enterprise in America on a mass scale. The conservative goal is to impose rule by conservative morality on the entire country, and beyond. Eliminating unions and public education are just steps along the way. Only progressive moral force can stop them.
The Little Blue Book is a guide to how to express your moral views and how to reveal hidden truths that undermine conservative claims. And it explains why this has to be done constantly, not just during election campaigns. It is the cumulative effect that matters, as conservatives well know.

The Cost of For Profit Health Care – Doctors for America

One of the most frustrating parts of being a Primary Care Physician in the U.S. is not being able to get necessary care for your patients because they cannot afford it. Last week I had to watch a 55-year-old woman with uncontrolled blood pressure and rapidly progressing kidney disease walk out of my office with only half of the medications she needed to control the blood pressure and stabilize her renal function. The medications were too expensive, she couldn’t afford adequate insurance coverage, and 22 months after being laid off from her job as a middle school teacher, was still looking for work. Later that morning I sighed helplessly as a 45-year-old diabetic patient told me he had to choose between buying his insulin and paying his rent. I knew if I were in his position, I’d be forced into the same decision.

The thing is, these patients both had health insurance. Such scenarios are unfortunately not unusual. A 2007 survey by the Commonwealth Fund found that even among Americans who were insured all year, 16 percent reported being unable to pay their medical bills, 15 percent had been called by a collection agency about medical bills, 10 percent changed their way of life to pay medical bills and 10 percent were paying off medical bills over time. Because of medical bills or accumulated medical debt, an estimated 28 million adults reported they used up all their savings, 21 million incurred large credit card debt, and another 21 million were unable to pay for basic necessities. And yet sixty-one percent of those with medical debt or bill problems were insured at the time care was provided.

Be wary of ad claims about health care law and brace for a wave of more: PolitiFact Ohio | cleveland.com

An independent payment advisory board created by the health care reform law “can ration care and deny certain Medicare treatments.”
Pat Boone makes this claim as the front man for an ad from the 60 Plus Association that aired this spring and targets five Democratic senators, including Ohio’s Sherrod Brown. The law creates a 15-member Independent Payment Advisory Board to suggest ways to limit Medicare’s spending growth, but the board may be overruled by Congress, and it makes no decisions about individual care. It is specifically forbidden from making any recommendations that would ration care, reduce benefits, raise premiums or cost-sharing or alter eligibility for Medicare. The 60 Plus Association was spending $720,000 on a campaign in Ohio aimed at Brown when PolitiFact Ohio ran the claim through the Truth-O-Meter and called it Pants On Fire.
The national health care reform is “a government takeover of health care.”
We’ve heard it before — so often that PolitiFact national named it the 2010 Lie of the Year — and we’ll surely hear it again. It has come recently from third-party advocacy ads. While the law gives the federal government a larger role in the health insurance industry, it relies overwhelmingly on the private market. In fact, the reform is projected to increase the number of citizens with private health insurance. PolitiFact has noted that the claim has been proven wrong over and over again. The rating: Pants On Fire.
The Affordable Care Act contains “a series of slush funds, set up to stay on the books automatically, with little or no oversight.”
So said House Speaker John Boehner in a news release and video, and again during debate on college student loan rates. PolitiFact Ohio found that the health care bill provides several pools of money that the secretary of health and human services can disburse for purposes designated by the legislation. But slush funds? Merriam-Webster defines a “slush fund” as “an unregulated fund often used for illicit purposes.” The money in question is designated for programs specifically defined by the law. Congress also has the power to oversee the bill’s implementation. The rating: Pants On Fire.
The health care law “slapped Ohio small businesses with a $500 billion tax increase.”
This statement came from the National Republican Senatorial Committee. PolitiFact Ohio found that the $500 billion figure was a fair number for total revenue raised nationally by the 2010 health care law, as estimated by the Congressional Budget Office at the time of the December 2009 vote on it. But the number for just taxes is lower, probably between $400 billion and $465 billion. The rest was for various other fees and revenue enhancements, and for all new revenue nationwide — not just for the share to be paid in taxes by small businesses in Ohio. To pick a national number and apply it to one segment of one state is not accurate, simply ridiculous and gets a rating of Pants on Fire.
“Preventive care . . . saves money for families, for businesses, for government, for everybody.” Ad claims in support of the health care law have been exponentially fewer than attacks, but this sweeping claim came from President Obama. Is preventive care a good idea? It can often save lives and keep patients healthier, and certain preventive measures may save money as well. But the findings of the Congressional Budget Office and physicians who have studied the medical literature say otherwise, including a Feb. 14, 2008, article in the New England Journal of Medicine that noted that “the vast majority” of preventive health measures that were “reviewed in the health economics literature do not” save money. The rating: False.
“Obamacare . . . will kill jobs across America.”
The U.S. Chamber of Commerce made this claim in ads that targeted Brown and other Democrats, and “job-killing” is the standard epithet applied to the health care law by opponents. PolitiFact looked at the best projections available when the claim was raised, based on how the law is actually written, and found that they do not suggest that the law will “kill” jobs. PolitiFact also looked at evidence provided by the Chamber to support its claim, including a brief from the Heritage Foundation, a conservative think tank that has been critical of the law. When the authors were asked whether their brief supported the claim, they responded that “our paper does not provide evidence that the [health care law] would cause job loss.” The rating: False.
The health care law “will cut $500 billion from Medicare.”
This claim from candidates and advocacy groups has been examined numerous times by PolitiFact national, PolitiFact Ohio and other PolitiFact state operations. The important point there is that $500 billion is not taken out of the current Medicare budget and that nowhere in the bill are benefits eliminated. The $500 billion represents the projected saving by slowing the projected growth in Medicare spending over 10 years. Medicare spending will still increase. The rating: Mostly False.

Reproductive Health – NYTimes.com

Re “The Campaign Against Women” (editorial, May 20):

The onslaught of laws focusing on denying reproductive health care rights is a concerted campaign against women. These laws are not grounded in science or evidence-based medicine.

The American Congress of Obstetricians and Gynecologists believes that access to family-planning counseling and to the full array of contraceptives is a basic and essential component of preventive health care for women.

Efforts to defund Planned Parenthood, which provides cervical cancer and mammography screening, contraception and other preventive care to millions of women, are egregious and disproportionately hurt poor women.

As physicians for women’s health care, ob-gyns see firsthand the havoc that punitive ideology-based laws have on the health of women and their families. These ill-conceived laws are based on the pretext of protecting health, but they do anything but that.

Mandating that women be legally forced to undergo transvaginal ultrasound or any other medical procedure against their will and against their physician’s judgment is an outrageous violation of patient autonomy and the confidential doctor-patient relationship. Decreasing access to family planning and contraception will only increase unintended pregnancies and negatively affect family and societal health.

Politicians were not elected to, nor should they, legislate the practice of medicine or dictate the parameters of the doctor-patient relationship. Our message to politicians is unequivocal: Get out of our exam rooms.

JAMES T. BREEDEN
President, American Congress
of Obstetricians and Gynecologists
Washington, May 22, 2012

Prostate Cancer Screening: What We Know, Don’t Know, and Believe

Overdiagnosis makes screening seem to save lives when it truly does not (6). Cases of overdiagnosed cancer fulfill histologic criteria for cancer, but are not destined to progress and kill within the patient’s natural lifetime. Yet, when detected through screening, these tumors are commonly treated, exposing patients to the harms of treatment without any true associated benefit. The man with such a cancer often believes that screening and treatment saved his life, but he would have been just fine had the cancer never been detected and treated. Overdiagnosis also increases the proportion of patients surviving 5 and 10 years. Lead-time bias increases apparent survival rates. Because screening diagnoses some patients earlier, they live longer after cancer diagnosis, even though they do not live longer than counterparts with similar cases of cancer that were not screen-detected. Overdiagnosis was known to be an issue in prostate cancer well before screening became popular. In the 1980s, the respected prostate cancer expert, Dr. Willet Whitmore, said that the quandary in prostate cancer is, “If cure is necessary, is it possible, and if cure is possible, is it necessary (7)?”

The screening literature stresses a difference between mass screening, in which large numbers of men are tested at an event, and screening within the physician–patient relationship. Much of my own concern about prostate cancer screening has been with mass screenings that mislead men to believe that screening can only help them. Over the past 20 years, celebrities, athletes, politicians, and prostate cancer survivor groups have endorsed screening. Mass screening is commonly conducted in shopping malls, churches, and community centers; at conventions and state fairs; and even in vans parked in grocery store parking lots. Hospitals, medical practices, fraternities, politicians, radio stations, television channels, and even an adult diaper manufacturer have sponsored mass prostate cancer screenings. Promotions for these events frequently discuss the high proportion of men with screen-detected tumors surviving 5 years and sometimes claim that screening saves lives. They never mention the potential harms of screening. Many well-meaning persons have supported screening activities and chose not to listen or believe those who have urged caution about screening. Mass screening is also a lucrative business. As Upton Sinclair once said, “It is difficult to get a man to understand something, when his salary depends on his not understanding it (8).”