Re: Health Reform's Taboo Topic
From: R. Daniel Braun (rd.braun@gmail.com)
Fri Jul 31 14:20:58 2009
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Somebody finally noticed one of the 800 pound gorillas in he room.
Dan
On Fri, Jul 31, 2009 at 1:14 PM, <RModugno@aol.com> wrote:
> From Today's Washington Post:
>
> Health Reform's Taboo Topic
>
> By Philip K. Howard
> Friday, July 31, 2009
>
> Health-care reform is bogged down because none of the bills before Congress
> deals with the staggering waste of the current system, estimated to be $700
> billion to $1 trillion annually. The waste flows from a culture of health
> care in which every incentive is to do more -- that's how doctors make money
> and that's how they protect themselves from lawsuits.
>
> Yet the congressional leadership has slammed the door on solutions to the
> one driver of waste that is relatively easy to fix: the erratic, expensive
> and time-consuming jury-by-jury malpractice system. Pilot projects could
> test whether this system should be replaced with expert health courts, but
> leaders who say they want to cut costs will not even consider them.
>
> What are they scared of? The answer is inescapable -- such expert courts
> might succeed and undercut the special interest of an influential lobby, the
> trial lawyers. An expeditious and reliable new system would compensate
> patients more quickly and at a fraction of the overhead of the current
> medical justice system, which spends nearly 60 cents of every dollar on
> lawyers' fees and administrative costs.
>
> Even more compelling, expert health courts would eliminate the need for
> "defensive medicine," thereby helping to save enough money for America to
> afford universal health coverage.
>
> Defensive medicine -- the practice of ordering tests and procedures that
> aren't needed to protect a doctor from the remote possibility of a lawsuit
> -- is ubiquitous. A 2005 survey in the Journal of the American Medical
> Association related that 93 percent of high-risk specialists in Pennsylvania
> admitted to the practice, and 83 percent of Massachusetts physicians did the
> same in a 2008 survey. The same Massachusetts survey showed that 25 percent
> of all imaging tests were ordered for defensive purposes, and 28 percent and
> 38 percent, respectively, of those surveyed admitted reducing the number of
> high-risk patients they saw and limiting the number of high-risk procedures
> or services they performed.
>
> Defensive medicine is notoriously hard to quantify, but some estimates
> place the annual cost at $100 billion to $200 billion or more.
> Quantification is difficult because defensiveness is now embedded in the
> culture of American health care; it's hard to separate the financial
> incentives from the distrust of justice. Yet every physician, and most
> patients, can give examples. In a recent letter to the Wall Street Journal,
> a Texas doctor described how, since being unsuccessfully sued in 1995, he
> has "doubled and tripled the number of tests and consultations that I
> order."
>
> A few years ago, I was not allowed to have minor knee surgery at an
> orthopedic hospital unless I went through a comprehensive "pre-operative
> examination." There was no financial incentive to the hospital because this
> pre-operative exam was to be done elsewhere. As it turned out, I had
> recently endured all those tests in my annual physical. But the orthopedic
> hospital would not accept month-old test results, nor even an explicit
> waiver by me of any liability. The result was pure waste: more than $1,000
> spent on wholly unnecessary tests.
>
> Health-care professionals live the reality of defensive medicine every day.
> Do an online search of the phrase "defensive medicine," and you will find
> scores of testimonials. But congressional leadership, amid all the talk of
> cost-containment, has assiduously avoided even mentioning the phrase.
>
> Containing costs, as Rep. Jim Cooper (D-Tenn.) noted on "Face the Nation"
> recently, requires overhauling the culture of health-care delivery.
> Incentives need to be realigned. That requires a legal framework that,
> instead of encouraging waste, encourages doctors to focus on what's really
> needed. One pillar in a new legal framework is a system of justice that is
> trusted to reliably distinguish between good care and bad care. Reliable
> justice would protect doctors against unreasonable claims and would
> expeditiously compensate injured patients. The key is reliability.
> Traditional "tort reform" -- merely limiting noneconomic damages -- is not
> sufficient to end defensive medicine, because doctors could still be liable
> when they did nothing wrong.
>
> The shifts in legal structure required to contain costs are hard to
> "score," using the terminology of the Congressional Budget Office. Only with
> experience can anyone quantify the real value of realigning incentives. But
> surveys and studies repeatedly confirm what every doctor knows -- that they
> go through the day ordering tests and procedures that aren't really needed.
>
> As the nation debates health-care overhaul, not addressing defensive
> medicine would be a scandal, a willful refusal by Congress to deal with one
> of the causes of skyrocketing health-care costs. The real crisis here is not
> that health care is broken; people of good will could come together and
> create the conditions for rebuilding the incentive structure of health-care
> delivery. The real crisis is that Congress is broken, and that it answers to
> special interests instead of the needs of all Americans.
>
> The writer is chairman of Common Good, a nonprofit legal reform coalition,
> and a partner with the law firm Covington & Burling LLP.
> ##################################################################
>
> Robert Modugno MD MBA FACOG
> Sylva, NC
> http://www.mysmoga.com
>
> ------------------------------
>
> ------------------------------
> ------------------------------
--
R. Daniel Braun, MD FACOG(L) ABMP CMTh #20900069
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
--
R. Daniel Braun
“Science without Religion is LAME; Religion without Science is BLIND"
Einstein 1941
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Somebody finally noticed one of the 800 pound gorillas in he room.<br><br>Dan<br><br><div class="gmail_quote">On Fri, Jul 31, 2009 at 1:14 PM, <span dir="ltr"><<a href="mailto:RModugno@aol.com">RModugno@aol.com</a>></span> wrote:<br>
<blockquote class="gmail_quote" style="border-left: 1px solid rgb(204, 204, 204); margin: 0pt 0pt 0pt 0.8ex; padding-left: 1ex;">
<div style="font-size: 10pt; color: rgb(0, 0, 0); font-family: Arial;"><font color="#000000" size="2" face="Arial">
<div>From Today's Washington Post:<br><br>Health Reform's Taboo Topic<br><br>By
Philip K. Howard<br>Friday, July 31, 2009 <br><br><br><br>Health-care reform is
bogged down because none of the bills before Congress deals with the staggering
waste of the current system, estimated to be $700 billion to $1 trillion
annually. The waste flows from a culture of health care in which every incentive
is to do more -- that's how doctors make money and that's how they protect
themselves from lawsuits. <br><br>Yet the congressional leadership has slammed
the door on solutions to the one driver of waste that is relatively easy to fix:
the erratic, expensive and time-consuming jury-by-jury malpractice system. Pilot
projects could test whether this system should be replaced with expert health
courts, but leaders who say they want to cut costs will not even consider them.
<br><br>What are they scared of? The answer is inescapable -- such expert courts
might succeed and undercut the special interest of an influential lobby, the
trial lawyers. An expeditious and reliable new system would compensate patients
more quickly and at a fraction of the overhead of the current medical justice
system, which spends nearly 60 cents of every dollar on lawyers' fees and
administrative costs. <br><br>Even more compelling, expert health courts would
eliminate the need for "defensive medicine," thereby helping to save enough
money for America to afford universal health coverage. <br><br>Defensive
medicine -- the practice of ordering tests and procedures that aren't needed to
protect a doctor from the remote possibility of a lawsuit -- is ubiquitous. A
2005 survey in the Journal of the American Medical Association related that 93
percent of high-risk specialists in Pennsylvania admitted to the practice, and
83 percent of Massachusetts physicians did the same in a 2008 survey. The same
Massachusetts survey showed that 25 percent of all imaging tests were ordered
for defensive purposes, and 28 percent and 38 percent, respectively, of those
surveyed admitted reducing the number of high-risk patients they saw and
limiting the number of high-risk procedures or services they performed.
<br><br>Defensive medicine is notoriously hard to quantify, but some estimates
place the annual cost at $100 billion to $200 billion or more. Quantification is
difficult because defensiveness is now embedded in the culture of American
health care; it's hard to separate the financial incentives from the distrust of
justice. Yet every physician, and most patients, can give examples. In a recent
letter to the Wall Street Journal, a Texas doctor described how, since being
unsuccessfully sued in 1995, he has "doubled and tripled the number of tests and
consultations that I order." <br><br>A few years ago, I was not allowed to have
minor knee surgery at an orthopedic hospital unless I went through a
comprehensive "pre-operative examination." There was no financial incentive to
the hospital because this pre-operative exam was to be done elsewhere. As it
turned out, I had recently endured all those tests in my annual physical. But
the orthopedic hospital would not accept month-old test results, nor even an
explicit waiver by me of any liability. The result was pure waste: more than
$1,000 spent on wholly unnecessary tests. <br><br>Health-care professionals live
the reality of defensive medicine every day. Do an online search of the phrase
"defensive medicine," and you will find scores of testimonials. But
congressional leadership, amid all the talk of cost-containment, has assiduously
avoided even mentioning the phrase. <br><br>Containing costs, as Rep. Jim Cooper
(D-Tenn.) noted on "Face the Nation" recently, requires overhauling the culture
of health-care delivery. Incentives need to be realigned. That requires a legal
framework that, instead of encouraging waste, encourages doctors to focus on
what's really needed. One pillar in a new legal framework is a system of justice
that is trusted to reliably distinguish between good care and bad care. Reliable
justice would protect doctors against unreasonable claims and would
expeditiously compensate injured patients. The key is reliability. Traditional
"tort reform" -- merely limiting noneconomic damages -- is not sufficient to end
defensive medicine, because doctors could still be liable when they did nothing
wrong. <br><br>The shifts in legal structure required to contain costs are hard
to "score," using the terminology of the Congressional Budget Office. Only with
experience can anyone quantify the real value of realigning incentives. But
surveys and studies repeatedly confirm what every doctor knows -- that they go
through the day ordering tests and procedures that aren't really needed.
<br><br>As the nation debates health-care overhaul, not addressing defensive
medicine would be a scandal, a willful refusal by Congress to deal with one of
the causes of skyrocketing health-care costs. The real crisis here is not that
health care is broken; people of good will could come together and create the
conditions for rebuilding the incentive structure of health-care delivery. The
real crisis is that Congress is broken, and that it answers to special interests
instead of the needs of all Americans. <br><br>The writer is chairman of Common
Good, a nonprofit legal reform coalition, and a partner with the law firm
Covington & Burling LLP. </div>
<div>##################################################################</div>
<div> </div>
<div>Robert Modugno MD MBA FACOG</div>
<div>Sylva, NC</div>
<div><a href="http://www.mysmoga.com" target="_blank">www.mysmoga.com</a><br></div></font><div><br><font style="color: black; font-family: arial,san-serif; font-style: normal; font-variant: normal; font-weight: normal; font-size: 10pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> <hr style="margin-top: 10px;">
</font></div></div>
</blockquote></div><br>
FACOG(L) ABMP CMTh #20900069<br>Professor Emeritus<br>Dept. of Obstetrics and Gynecology<br>Indiana U. School of Medicine<br><br><br>R. Daniel Braun<br>
<br> “Science without Religion is LAME; Religion without Science is BLIND"<br> Einstein 1941<br>
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