• Reflex: August 23, 2011

    Ezekiel Emanuel and Jeffrey Liebman recommend “smart cuts” to Medicare and defend the ACA’s approach. “Smart cuts eliminate spending on medical tests, treatments and procedures that don’t work — or that cost significantly more than other treatments while delivering no better health outcomes. And they can be made without shortchanging patients. There are plenty of examples.” Austin’s comment: Emanuel and Liebman then provide examples and contrast them with the penny-wise, pound-foolish approaches being considered in Washington. For more see Rita Redberg and my memo to the supercommittee.

    Clinical trials on the gene TOMM40 and the drug Takeda to predict/slow Alzheimer’s onset beginning, reports the Raleigh (N.C.) News and Observer. Don’s comment: genetic markers could also be useful as risk rating variables for private long term care insurance, a use of genetic information not banned by the Genetic Non-Discrimination Act of 2008.

    Hospital volume, provider volume, and complications after childbirth in U.S. hospitals. A study published in Obstetrics and Gynecology found that providers who performed fewer than seven deliveries per year (which was the lowest quartile) had a 50% higher odds of complications compared to obstetricians in the highest quartile of number of deliveries. Aaron’s Comment: It seems like common sense, but practice makes perfect. There’s a real tension between providing doctors without enough experience to get good at what they do, and people’s legitimate fears of not wanting doctors who have too little experience.

    Hat tip: Igor Volsky’s Morning CheckUp.

    • Our network has purchased a couple of smaller hospitals. I have been working on changing the way that we staff these small places so that we make sure everyone has up to date experience. Going to mean a lot of driving.


    • Are Medicare Advantage plans permitted to deny coverage for ineffective services or are they required to provide all of the benefits that Medicare provides. Has anyone studied private insurance (for people under 65) to determine if they do a better job of defining medical necessity or go to far in the opposite direction (e.g.denying or delaying services that might make a difference?