How putting in a pacemaker could wreck a family's life....

On 06/23/10 6:44 AM, Mike Barrett wrote:

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I like the 3M model, None of them will be able to keep pace with the coming changes in documentation and disease management intervention.  Doesn't mean we don't use them, just know their limitations.

It has been my thought that one of the needed stimulus is finding a couple of docs that are the true bad actors and put them in jail for doing unnecessary procedures - over utilization at the extreme is licensed mugging - cutting people for money.  This would change the whole nature of defensive practice of medicine.

Think about it, we put accountants, lawyers, etc in jail all the time.  The people figuring out the crimes are other accountants and lawyers.  We don't have a similar function for physicians.  Physicians, accountant, lawyers and others are in the same position of high trust / expertise versus their consumer client.  We really don't have the same enforcement / accountability mechanism.  Buying malpractice insurance, etc, etc is unpleasant, but jail time... whole other issue.

Lastly, we need to separate - difficulty - chronic from episodic/catastrophic care.  Chronic eats up the vast majority of dollars and is the very poorly managed.  Episodic/Catastrophic grabs the headlines, but really isn't the systemic cost.  Further what one does to managed chronic, skill sets, tools, etc are competely different than what is done in a heroic measures catastrophe. 

Thanks for spawning the debate.

Mike: So right On, you are!  I'm not so draconian-minded, but we're on the same page on all these issues.  Did you read: "What Broke My Father’s Heart" online at http://www.nytimes.com?

"Last year, doctors, hospitals, drug companies, medical-equipment manufacturers and other medical professionals spent $545 million on lobbying, according to the Center for Responsive Politics. This may help explain why researchers estimate that 20 to 30 percent of Medicare’s $510 billion budget goes for unnecessary tests and treatment. Why cost-containment received short shrift in health care reform. Why physicians like Fales net an average of $173,000 a year, while noninvasive cardiologists like Rogan net about $419,000.

The system rewarded nobody for saying “no” or even “wait” — not even my frugal, intelligent, Consumer-Reports-reading mother. Medicare and supplemental insurance covered almost every penny of my father’s pacemaker. My mother was given more government-mandated consumer information when she bought a new Camry a year later.

And so my father’s electronically managed heart — now requiring frequent monitoring, paid by Medicare — became part of the $24 billion worldwide cardiac-device industry and an indirect subsidizer of the fiscal health of American hospitals. The profit margins that manufacturers earn on cardiac devices is close to 30 percent. Cardiac procedures and diagnostics generate about 20 percent of hospital revenues and 30 percent of profits." 

"My Father's Broken Heart; How Putting in a Pacemaker Wrecked My Family's Life" by Katy Butler The New York Times Magazine June 20, 2010: 39-43.