January 24, 2012
3:40 pm
If you’ve ever watched the movie “The Sixth Sense,” you see what a talented director and writer can accomplish by withholding critical information from the audience. In that movie (and, no, I’m not going to spoil it if you haven’t seen it), M. Night Shyamalan holds back an essential fact about Bruce Willis’s main character until the very end of the film. When that fact is revealed, it changes the entire context of what we thought we knew about the story.
What works well, though, in the cinema isn’t necessarily a sound methodology when it comes to public policy matters that affect lives. Transparency is public matters is virtually always a good thing, but when the practice of transparency reveals facts without context, it can be counterproductive.
Dr. Thomas Stossel, a professor of medicine at Harvard Medical School, discussed this issue in a Wall Street Journal op-ed this week, “Who Paid For Your Doctor’s Bagel?” In his op-ed piece, he discusses the Physicians Payment Sunshine Act, a new law that will require medical innovation companies to disclose any transfer of value to physicians. The Centers for Medicare and Medicaid Services (CMS) has recently issued draft guidelines for implementation of the new law.
Again, in principle, this type of transparency is a good thing. But when the new law results in a list of consulting fees and other payments made by pharmaceutical and medical device companies to physicians, there will be a piece of the puzzle still missing. What is the purpose of that exchange beyond a minimalist bureaucratic definition such as “consulting fee?” What was the impact for patients and for the current and future practice of healthcare? Without this context, negative inferences can be made about any exchange of value.
As Stossel wrote in the Journal, “The media already exploit disclosures….to demean physicians compensated by royalties from useful inventions that they license to companies, or who were paid consulting fees for advice concerning the optimal use of products, or for educating other physicians about products.”
The fact is that collaborations between physicians and industry have led to some of the most important medical breakthroughs of the last several decades. Physicians help guide industry on how to make new innovations beneficial for patients. Companies train physicians on the optimal use of new drugs and devices. This sharing of knowledge is essential to the advancement of healthcare.
We’ll be discussing this issue in greater detail in the months ahead. HLC launched an initiative called the National Dialogue for Healthcare Innovation and, through this effort, multiple organization representing healthcare providers, health industry sectors, academia and patients have been developing a consensus set of principles to help guide future physician-industry collaborations. More to come.
March 11, 2011
9:19 am
For all of the criticisms of our nation’s healthcare system and the improvements that need to be made, there is one undeniable truth that was brought to the forefront again this week – our healthcare providers continue to make tremendous progress helping people overcome diseases which used to be viewed as unavoidable death sentences.
The Centers for Disease Control and Prevention issued a report yesterday that showed we now have nearly12 million cancer survivors in the United States. That’s an approximately fourfold increase since 1971 in the number of people who have conquered cancer.
The leading subsets of this population are the 2.6 million who have survived breast cancer and 2.3 million men who have overcome prostate cancer. The CDC credited earlier detection, improved diagnostic methods and more effective treatments for these successes.
The good news is that these statistics should continue to improve. With advancements in genetic-based healthcare, we are increasing our ability to not only diagnose diseases at an earlier stage and be more precise in recommending treatments, but physicians will also be better able to see a patient’s propensity for disease based on their genetic makeup.
This is just another reminder of the need for policymakers to encourage advancements in medical innovation. This growing population of cancer survivors is prime evidence of what happens when our healthcare system is centered around new innovations in treatments, technologies and medications.
February 15, 2011
11:35 am
Now that gasoline is over three dollars a gallon, I wince a little every time I fill up my car. It would be nice to have the power to simply decree that gas prices be 50 cents lower, but I understand that my pocketbook preferences do not take precedence over basic marketplace factors that range from the cost of oil exploration to rising energy demand in China and India.
There is still an insistence on the part of some, though, that governments should set healthcare prices (more than is already the case in Medicare and Medicaid), regardless of actual cost of producing and delivering healthcare goods and services.
This issue arises because of a report from Boston’s National Public Radio affiliate, WBUR-FM, that the Massachusetts Governor may ask the state legislature for the authority to set the rates that hospitals can charge. That authority would kick in if, after three years, hospitals are requesting increases of more than two percent.
This idea of government setting prices is, of course, neither new nor limited to the Bay State. During the debate over health reform, proponents of a government-run health insurance option cited Medicare as a model of “efficiency” because it establishes the payment levels that physicians and hospitals can receive. That’s fiat, not efficiency. Similarly, there are constantly proposals bandied about to affix price ceilings to virtually every healthcare sector from insurers to pharmaceuticals to medical devices. That’s also the problem with the Independent Payment Advisory Board, scheduled to be implemented as part of the Affordable Care Act. It’s an entity empowered to slash healthcare spending without regard to achieving greater quality or value.
The problem with having government simply decree what any one sector may charge for its services is that this approach ignores the interrelationship between insurers, providers, manufacturers and consumers in determining the value of healthcare services. It also undermines the ability of health system participants to provide greater value through innovation.
There’s no question that we do need to focus on improving healthcare’s affordability. The way to do that, though, is through new, innovative health delivery mechanisms, a greater reliance on evidence-based medicine, a more intense focus on wellness and prevention and strengthening the ability of consumers to be discerning healthcare shoppers.
For government to simply declare that certain prices must be lower may bring a measure of short-term relief, but there’s a price to be paid, whether it’s in the form of cost-shifting, reduced access, impaired quality or less innovation. Just saying a cost is lower isn’t the same as actually making it lower through marketplace mechanisms or greater ingenuity.
January 28, 2011
10:23 am
Medical liability reform is one of those causes that, up to now, has seemed a political impossibility at the federal level. Even in years when Republicans controlled both the U.S. Senate and House, tort reform advocates couldn’t muster sufficient votes to get legislation passed. A number of states have enacted reform measures, but Congress – encouraged by strong lobbying from the nation’s trial attorneys – has stubbornly refused to rein in even the most meritless lawsuits.
Now, though, we’re seeing a number of actions taking place that indicate there may be an opening to get something done on liability reform. Among them:
• President Obama made it a point to mention medical liability reform in his State of the Union speech.
• The President’s deficit reduction commission has cited comprehensive liability reform as a recommended action to contain healthcare costs.
• Medical liability reform legislation has just been introduced in the House of Representatives, and it has bipartisan sponsorship.
• There is increasing interest in innovative measures such as tying liability protections to usage of health information technology and evidence-based medicine.
There are compelling reasons for Congress to move on this issue. We have to be concerned about having a sufficient supply of physicians to serve an insured patient population that will increase as a result of health reform. In many states, the liability climate forces physicians into early retirement. We’re concerned about making our healthcare system more cost efficient, and yet the current liability system forces the expenditure of dollars in ways that don’t benefit patients. President Obama’s right. It’s time to make progress on this issue.
January 10, 2011
4:43 pm
Even before Congress passed the Affordable Care Act, the actual process of reforming our healthcare system was already taking place at locales throughout the country. In all sectors of American healthcare, we’re seeing innovators who are developing new and better ways of delivering high-quality, cost-effective care to patients.
The publication SmartBusiness spotlighted one of these innovators, Barry Arbuckle, Ph.D., the president and CEO of the MemorialCare Health System in southern California. In an interview, Dr. Arbuckle discussed how physicians in the MemorialCare system are practicing evidence-based medicine that is bringing about patient outcomes that “frequently exceed state and national averages for most diseases.”
In the interview, Dr. Arbuckle, a member of the Healthcare Leadership Council, also discussed the critical role of electronic patient records and offers advice for employers on the questions they need to ask to ensure the best possible healthcare for their employees.
The theme of best practice, evidence-based medicine is one we’re going to hear about frequently as the nation’s healthcare system continues to transform itself.
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