Thursday, December 02, 2010

Health Care Reform: Cutting Supply of Care to reduce Costs of Care?

An example of the weird way the Feds approach the high costs of care not be adding to supply, but by cutting supply.  Solving the problem of the scarcity of care, by making care more scare.  In this case the care is Durable Medical Equipment for seniors.
North Carolina’s leader in home medical equipment advocacy and education, NCAMES, is mobilizing its membership base to support efforts led by Rep. Sue Myrick (R - NC, 9th District) to have the Federal government address fatal flaws in a bidding program affecting thousands of seniors and patients in need beginning in January 2011. The bidding program decides which home medical equipment companies can service patients who use Medicare to pay for their equipment

Copies of a November 24 letter co-signed by Rep. Myrick and Rep. Bruce Braley (D - IA, 1st District) which was sent to Donald Berwick, M.D., Administrator for the Centers for Medicare and Medicaid Services (CMS), were distributed to hundreds of NCAMES member companies statewide. In the letter, Reps. Myrick and Braley press Dr. Berwick about a recent study revealing that more than 40 percent of the companies selected by CMS’ flawed bidding program to provide HME services are financially unstable and unable to provide necessary medical supplies.
“The bidding program managed by Dr. Berwick’s agency is killing small businesses across North Carolina and needlessly endangering thousands of home medical equipment patients,” Beth Bowen, NCAMES Executive Director, said.
According to Bowen, testimony at a Congressional Subcommittee hearing this past September was overwhelmingly against the CMS bidding program, with example after example given of its negative effects such as forcing home health care patients into institutional care. Bi-partisan support for halting the bidding program has been growing over the past few months, Bowen said, with elected officials like Rep. Myrick pushing CMS harder to address concerns.
For example, Rep. Myrick pointed-out in her letter that many contract winners chosen by CMS actually have credit limits of less than $10,000, are on credit hold, or are so far behind on their payments that their accounts have been turned over for collections or legal process.
The CMS bidding program, “has a poor track record” Myrick wrote, emphasizing that seniors will have difficulty obtaining the supplies and services they need, and “The new system could drive out quality suppliers who have reliably served seniors in the past.”
And here's Don "PJ" Berwick's response to Congress via Bid News Blog,
WASHINGTON — AAHomecare reports that in his first appearance at a Nov. 17 hearing on health reform before the Senate Finance Committee, CMS Administrator Donald Berwick, M.D., singled out national competitive bidding program as an example of how the federal government can save money.

When Sen. Orrin Hatch, R-Utah, questioned him about projected savings under the Affordable Care Act, Berwick responded that the costs of DME had fallen 32 percent in “the trial” (Round 1) of the bid program, “returning something like $150 million I think back to beneficiaries in those nine trial areas.”

According to AAHomecare, “Berwick focused only on short-term savings attributable to the bidding program and not on the sharp reduction in patient choice and access to quality care that will result from the misguided program and the badly designed bidding system.”
Focused only on short-term savings. Next step is reduce demand-for-care to meet the reduced supply-of-care and Liberalism's getting pretty raw about how to reduce demand for care.

2 comments:

Dan Harper said...

Recently, I had a conversation with a retired hospital executive. His solution to cutting costs was to pay close attention to services provided in the last few months of life, which (in his view) meant training doctors in a better understanding of how to deal with end-of-life issues, including having them understand that often people live longer in hospice (which is cheap) than they do when the doctors order tons of heroic measures to prolong life a few extra weeks. Very interesting.

Bill Baar said...

A doc should never be heroic and they should never order measures a patient doesn't want. These are our bodies they're poking after all.

What grates me are the notions that spending a larger portion of our income on health care is a bad thing.

For most of use the larger share of that expense will be in our twilight years regardless of how wise we, and our providers, and clergy are on giving us good advice on end-of-life-planning.

That's not at all a bad thing to spend money on after all. (My personal experience here is convincing people to hang on and not give up... depression is an awfully prevalent thing, and modern Medicine can do a whole lot if people will let it).

What I fear are government panels stepping in to decide these protocols for us. That would be a very bad thing for Government to do. Advise maybe as NIH has done in the past, but for the Gov to take over as payer and protocol builder here is I think a bad path to go down.