db's Medical Rants

New Medicare Law Boosts to Chronic Care
The goal of this heightened monitoring is to prevent a medical crisis that could send the patient to the hospital. Such coordinated care for people with chronic illnesses such as diabetes, heart disease and high blood pressure is the focus of disease management programs, which got a [...]

I love the intellectual interchange between blogs. Matthew Holt has stimulated my thinking, and hopefully I have reciprocated. As he has updated his entry (with reference to yesterday’s rant), I will respond specifically to a couple of his points. His permalink is working now – QUALITY: Why doesn’t evidence-based medicine happen in [...]

Many physicians still clamor for universal health care in the US. We must look at international models to better guess what such a system would do to our health care. Perhaps we would still have an active private medical care system. Great Britain does. Private health: bigger than NHS!
This week, BBC [...]

Matthew Holt of The Health Care Blog fame partially nails this issue – QUALITY: Why doesn’t evidence-based medicine happen in practice? (permalinks do not work, so scroll to Thursday, Dec. 11).
My conclusion is that no evidence-based guideline will be perfectly applied. Some don’t take into account the human situation of the patient. [...]

Health ‘blogs’ are multiplying – thanks to Matthew Holt at the Health Care Blog for the link. And yes I am included, along with one of my more erudite comparisons!
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I received this question today:
I’m the Living with Diabetes blogger… and something has come up on the insulin pumpers list, that needs to be commented on by a medical doctor, especially one like you who teaches other medical doctors. Several people on the list are amazed, dumbfounded, etc. that both family [...]

Studies confirm risks of ‘economy class syndrome’ This report refers to 3 studies. Those studies show the following risk factors – longer than 6 hour flights, increased age, being overweight, birth control pills. The risk is very low, however, I would recommend (and when I fly I do this) getting out of [...]

While many conservatives have criticized the Medicare bill as being too costly, others have supported it. This columnist does a nice job of emphasizing his positive opinion. Making Medicare Reform Work
Conservatives like to point out that only a small percentage of seniors have a problem paying for prescription drugs. In fact, [...]

I blogged on this story last week. This article adds important information to the discussion. I was at a birthday party over the weekend (for a 50 year old), and had several people ask me about virtual colonoscopy. I suspect most physicians are getting these questions. Not quite in a comfort zone
[...]

Apparently, many 50 year olds want a colonoscopy. 50 and Ready for a Colonoscopy? Doctors Say Wait Is Often Long
“It’s fine to say everyone should have a colonoscopy,” Dr. Bond said. “But we are talking about 70 million people. It is unclear whether that is even feasible in the United States.” [...]

A reader provided this link. Here is a public thanks! Stealth Merger: Drug Companies and Government Medical Research
Increasingly, outside payments to NIH scientists are being hidden from public view. Relying in part on a 1998 legal opinion, NIH officials now allow more than 94% of the agency’s top-paid employees to keep their [...]

Study Questions Some PSA Prostate Tests Remember this important principle. Preventive medicine works best for those with longer life spans. At some point (difficult to assess admittedly), the potential for gain from prevention may no longer exist. Obviously, it depends on the type of prevention. Flu vaccines are likely [...]

Today’s NEJM has a nice summary of the Canadian drug issue (for subscribers) – Canadian Drugs

Evidence of harm from these transactions is sparse. A single case of potentially serious harm has been made public: in January, an Oregon woman filed suit against Medicine Shoppe Canada, alleging that a bottle meant to contain tamoxifen actually [...]

That Ounce of Prevention Grew Too Big
Nowadays, I think the practice of medicine is hard for different reasons. Not long ago I saw a new patient in my cardiology clinic. He was an elderly man who spoke only French, so I had to call for an interpreter. When I finally got someone on [...]

On the road at a retreat, so I have not had a chance to read the NEJM article. The NY Times review makes sense and puts the issue into perspective – A Gentler Type of Colonoscopy Proves Effective

The study included 1,233 people ages 50 to 79 who agreed to have a virtual colonoscopy [...]

Primary care troubled by coding errors: Medicare officials suggest doctors may have trouble deciphering evaluation and management guidelines in billing. Doctors may have trouble deciphering – Medicare officials use understatement to negligible effect.
The American College of Physicians said, given the difficulty even experienced professionals have with E&M coding, CMS should not include in the [...]

Doctors get a 1.5% pay hike as Congress passes Medicare reform
I will use this summary to provide my opinions on several provisions. My comments in italics.

Sweeping overhaul of Medicare
The almost 700-page Medicare legislation represents the broadest reform of the program since its inception. Provisions affecting physician practices and patients include those that:
[...]

One provision of the Medicare bill that excites me is the adjustment for rural hospitals and physician payments. Apparently New Yorkers disagree. City Hospitals Reap Little in Medicare Bill Here in Alabama (and similar states) we have a huge problem providing adequate care in our rural areas. Finances play a major [...]

Europeans mull costs, benefits of free medical care
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A $400 Billion Purchase, All on Credit
But although some economists on the left and right might wring their hands, younger workers don’t seem to be complaining. According to polls, members of the post-boomer generation are actually more enthusiastic than their elders about this new legislation. Their feeling is partly due to a desire to [...]

Over the past 2 years I figured out that Medicare was overpaying for cancer chemotherapy. We had a big jump in residents choosing oncology for fellowship. (I know this is a cynical jump in logic, but it does make sense). It appears that congress has adjusted. Doctors fear lower Medicare drug payments [...]

These links are provided for those who want a broad view of the new Medicare legislation. The breadth offered reflects our uncertainty concerning many provisions of the bill.

Medicare Plan for Competition Faces Hurdles – which suggests that we may never have the competitive options available – and explains why
Holding Down Drug Prices [...]

from The Arc of the Pulmonary Artery Catheter (paid subscription required)

In the 1980s, observational studies of patients with acute coronary syndromes distinctly challenged the utility and safety of this intervention, suggesting higher mortality for patients receiving a PAC. In 1996, a retrospective observational study of 5735 critically ill patients suggested that the PAC was [...]

Surgeon Caseload Largely Explains Hospital Volume Link to Mortality
Numerous reports have shown that operative mortality is lower at hospitals with high procedural volumes. Now, new research suggests that this association is largely mediated by the caseload of the operative surgeon. Therefore, a patient undergoing surgery at a low-volume hospital by [...]

Surgeon Caseload Largely Explains Hospital Volume Link to Mortality
Numerous reports have shown that operative mortality is lower at hospitals with high procedural volumes. Now, new research suggests that this association is largely mediated by the caseload of the operative surgeon. Therefore, a patient undergoing surgery at a low-volume hospital by [...]

For those who want to read a wide variety of opinions, here goes:

Am I sad or am I glad? – from Assymetrical Information
POLICY: Medicare bill passes from the Health Care Blog
Will Medicare now cover my depression about domestic politics? from Daniel Drezner
Almost everything over at The Business [...]

This is the second post on the Medicare bill. Many critics dislike the provision which allows participants to choose another insurance plan. In trying to understand this opposition, I am assuming that critics worry about a dilution of Medicare as we know it. Thus, we must ask if we would rather [...]

This is the first in a short series of commentaries on the Medicare bill. The essence of the bill is captured in the first post today (since I post in reverse chronological order, scroll down). The drug benefit has 2 parts. For ‘04 and ‘05, seniors can buy (for $30) a discount [...]

Starting in April, Medicare beneficiaries could get a prescription drug discount card that would yield savings estimated at 15 percent to 25 percent. Low-income beneficiaries would also get a $600 subsidy applied to the card but would still be required to make a co-payment of between 5 percent and 10 percent for each [...]