by Max Brantley
A Little Rock doctor stopped me on my morning walk yesterday to say that a worthy newspaper project would be unnecessary medical procedures.
He was inspired by a recent USA Today study that found that 10 to 20 percent of all surgeries in some specialties are unnecessary. My sidewalk commentator said unnecessary procedures go beyond surgery to testing. I was reminded of the super-expensive radiologic stress test a doctor once ordered up for me at St. Vincent, conceding in the process it probably wasn't a necessity, but, you know, can't be too careful.
The subject arose again this morning in a New York Times op-ed in which a medical expert says overcharging for medical procedures (many of them unnecessary in the first place) had reached criminal proportions. He notes that Medicare and private insurers can negotiate down exorbitant costs set by providers, but not the uninsured. Thus, those least able to pay are charged sticker price and sometimes wind up in medical bankruptcies as a result.
Consider another recent shift in health care: hospitals have been aggressively buying up physician practices. This could be desirable, a way to get doctors to use the same medical record so that your primary care practitioner knows what your cardiologist did.
But that may not be the primary motivation for these consolidations. For years Medicare has paid hospitals more than independent physician practices for outpatient care, even when they are providing the same things. The extra payment is called the facility fee, and is meant to compensate hospitals for their public service — taking on the sickest patients and providing the most complex care.
But now hospitals are buying up independent practices, moving nothing, yet calling them part of the hospital, and receiving the higher rate.
Then there are colonoscopies, a fabulous revenue center that I mulled on recently after my own run through a local hospital-owned cash register.
There are good reasons to believe that they can reduce the number of deaths from colon cancer. Expert panels recommend that most people need a colonoscopy only once every 10 years. But a study published in 2011 in The Journal of the American Medical Association found that 46 percent of Medicare beneficiaries with a normal colonoscopy nevertheless had a repeat exam in fewer than seven years. For some gastroenterologists, it seems, the primary finding from your colonoscopy is that you need another one.
Indeed, it was suggested to me that three years wasn't a bad idea for repeats — five certainly.
Yep, a good topic for study.
It will be interesting, then, to see where the new Arkansas Medicaid fraud czar focuses the laser beam of oversight. On that Cadillac-driving, lobster-eating, food stamp-carrying welfare parasite? Or on the real blood suckers?
I'm reminded, too, of the favorite talking points of opponents of universal health care: Rationing, death panels, long waits for elective procedures. It might be we need some rationing (better known as wise and efficient use of the system, without unnecessary, expensive procedures). It might be we need death panels (better known as smartly considered treatment in the crazily expensive final months of life). It might mean we need to eliminate unnecessary testing and treatment (try telling that to the doctor with a Maserati payment.) But, no. Here in the greatest country on earth we believe in paying the highest cost for medical care that, as yet, produces life expectancy far shorter than that of our medically cheaper, socialistic peers
SPEAKING OF HEALTH CARE: Here's another wrinkle in the picture (Times Record, Fort Smith), a move to end regional organizations that oversee quality and delivery of Medicare. The organization under the gun here is the Arkansas Foundation for Medical Care, which employs 190 in Fort Smith and Little Rock.