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Health Care Treatment Cost Effectiveness
Old 05-30-2011, 11:18 AM   #1
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Health Care Treatment Cost Effectiveness

The article talks about medicare, but I believe the same applies to private insurers.

Curbing Medicare Costs Without Vouchers - Rasmussen Reports™

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About 10 years ago, a new radiation treatment for prostate cancer came on line. A single course of "intensity-modulated radiation therapy" cost Medicare about $42,000. The older radiation therapy cost $10,000. Hospitals bought the new machines and stopped using the traditional method. This tacked another $1.5 billion per year to Medicare spending on prostate cancer alone.

Did the fancy new machines do a better job than the old ones? Medicare did not inquire. It just paid. Amazing.

First, look at the existing setup. For most any treatment deemed "reasonable and necessary," Medicare pays the cost plus some profit. This has turned the program into a brainless check-writing machine for the medical-industrial complex.
Our country should be studying the various treatment options for various disease to determine the optimum effective treatment taking into account cost. Then just pay for the cost of that option. If a doctor or patient wishes a different treatment option; fine. But the insurer or medicare should only be liable only up the cost of the optimum effective treatment. The balance is up to the patient to self fund or find an insurer willing to provide the extra coverage for treatment above the optimum effective treatment.
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Old 05-30-2011, 11:27 AM   #2
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I think you hit the nail on the head!

The other day when listening to NPR as they interviewed a physician the following comment caught my attention: "Doing all you can is not always doing what you should for the patient."
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Old 05-30-2011, 12:24 PM   #3
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Dartmouth did a study regarding medicare & the amount of care provided. The link is to a map that shows the wide variation of the amount of care provided to seniors. In some parts of the country up to 3 times the amount of health is provided to no effect as seniors health is pretty constant nationwide.

Dartmouth Atlas of Health Care: Regional Disparity in Medicare Spending - Interactives - Newsroom - Quality/Equality - RWJF

Dartmouth Studies Show Wide Variations in Hospital Care and Outcomes for Chronically Ill Medicare Patients - RWJF

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Medicare patients with similar chronic conditions receive strikingly different care, even among hospitals identified as "best" for geriatric care by the magazine U.S. News & World Report, according to Dartmouth Medical School studies released today. The studies, featured in the Oct. 7 Web-Exclusive edition of the journal Health Affairs, show that the frequency of physician visits, the number of diagnostic tests, and rate of hospital and intensive care unit (ICU) stays vary markedly. The studies show that a higher intensity of care and higher level of spending are not associated with better quality or longer survival times even in the most renowned teaching hospitals.
In fact, there is evidence that a very high intensity of care for people with certain terminal medical conditions might hasten death, the researchers report. New findings identify, by hospital, where Medicare enrollees are receiving much more intensive care for common medical conditions, raising questions about usual methods of identifying "best" hospitals.
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Old 05-30-2011, 03:25 PM   #4
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The Debate Over Digital Mammograms - Newsweek

The issue of increasing cost without improving the outcome of the patient is widespread in our health care system. I've linked just one more example to add to the list.

Anyone believing that the health care industry has a patient's best interests at heart is foolish. It's all about money. I know this is a generalization....but I believe in the vast majority of cases it is true. Health care providers don't want people to die because this ends a revenue stream.
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Old 05-30-2011, 05:50 PM   #5
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The cost of healthcare in America is increasing much faster than the cost of living. The aggregate monies spent on healthcare as a percentage of GNP is on a fast rise to be signficantly higher than any other other country in the western world. This will become a competitive disadvantage. At the same time, health statistics, mortality rates show no benefit to this spending compared to those other countries. It is not a promising situation.
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Old 05-30-2011, 06:56 PM   #6
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Originally Posted by tjscott0 View Post

Our country should be studying the various treatment options for various disease to determine the optimum effective treatment taking into account cost. Then just pay for the cost of that option. If a doctor or patient wishes a different treatment option; fine. But the insurer or medicare should only be liable only up the cost of the optimum effective treatment. The balance is up to the patient to self fund or find an insurer willing to provide the extra coverage for treatment above the optimum effective treatment.
That would be a sensible approach. Outright denial backfires all the time. You see private insurers hammered because they didn't approve some new treatment that a terminal patient believes would save his life. The PR gets hot enough and they flip flop. Allowing treatment but paying only the lesser option's cost until the new approach passes some agreed upon bar sounds like an better approach. I would guess there are some legitimate concerns about that too.
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Old 05-30-2011, 08:11 PM   #7
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Squandering Medicare money - St. Petersburg Times

I thought this was an interesting article as one of the first things my 76-year old mother's new doctor (new to my mother and a relatively new doctor) recommended was a screening colonoscopy. Mom was having no issues and she has never had a colonoscopy. Mom declined.
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Old 05-30-2011, 08:42 PM   #8
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Squandering Medicare money - St. Petersburg Times

I thought this was an interesting article as one of the first things my 76-year old mother's new doctor (new to my mother and a relatively new doctor) recommended was a screening colonoscopy. Mom was having no issues and she has never had a colonoscopy. Mom declined.
I read the article and I am unimpressed. Basically, it says who cares if a 75 year old has colon cancer, he or she will likely die of something else before they can log another 8 years.

A few problems with that are 1)This sounds like an average from a large group. How about the poor stiff whose cancer develops more rapidly? In your mother's case, what if she already has a cancer which she does not know about since she has never had the procedure? 2) 75+8=83 years old. But many, many 75 years olds will live beyond 83 in good health, that is unless stupidly applied cost containment plans doom these otherwise healthy people to spend their remaining life with a colostomy bag and a lot of pain.

Great plan! The Grey Panthers had better develop their public relations chops. I'll be right there with them.

Ha
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Old 05-30-2011, 09:21 PM   #9
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Quote:
The Debate Over Digital Mammograms - Newsweek

The issue of increasing cost without improving the outcome of the patient is widespread in our health care system. I've linked just one more example to add to the list.
On this one item, I have no doubts about its effectiveness.

My wife had a standard mammogram and then a digital mammogram, which found a tumor that the first one did not find. It saved her life.

My dentist is delighted with digital x-rays. They expose the patient to less radiation, and by adjusting the contrast and so forth, he can see details that were not clear before. The photos appear to be higher resolution, too.

Digital imaging proved valuable a few years ago in another area. For a long time, there was a debate about whether or not yeast cells had a distinct nucleus. One day a teacher had yeast cells under a microscope with a digital camera on it, adjusted the picture and lo-and-behold, there was a nucleus. It was just hard to see.

It is a better tool, IMHO. How well it is used is another question.
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Old 05-30-2011, 09:47 PM   #10
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Ed...sounds like newer technology made a difference in your wife's case. Or....maybe the radiologist reading the tests made the difference. We'll never know. I'm glad she's OK.

There is still some debate about the effectiveness of colonoscopies related to improving outcomes in colon cancer. Once alternative with good results is fecal occult blood testing (FOBT), which costs more than 90% less then a colonoscopy.

How does colonoscopy compare with fecal occult blood testing as a screening tool for colon cancer? — The Journal of Family Practice

This is not as recent as other articles that I've read, but gives a brief overview of the issue. Compliance with getting screened is a huge issue, and one of the primary reasons a physician will try to get a patient to have a colonoscopy. But I firmly believe that more people would comply with doing a FOBT if they were just given that option, and received good instruction on how to do it.

It's inexpensive, easy, and a good initial screening tool. But we don't hear much about it because there isn't much money to be made providing it to patients. (my bias)
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Old 05-30-2011, 09:49 PM   #11
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Originally Posted by haha View Post
I read the article and I am unimpressed. Basically, it says who cares if a 75 year old has colon cancer, he or she will likely die of something else before they can log another 8 years.

A few problems with that are 1)This sounds like an average from a large group. How about the poor stiff whose cancer develops more rapidly? In your mother's case, what if she already has a cancer which she does not know about since she has never had the procedure? 2) 75+8=83 years old. But many, many 75 years olds will live beyond 83 in good health, that is unless stupidly applied cost containment plans doom these otherwise healthy people to spend their remaining life with a colostomy bag and a lot of pain.

Great plan! The Grey Panthers had better develop their public relations chops. I'll be right there with them.

Ha
She did the fecal occult test but had no desire to get scoped.
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Old 05-30-2011, 09:53 PM   #12
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This got my attention as they talked about prostate cancer. My husband has it; he received the 'fancy' IMRT and we will know this week how well it worked.

Now...this is just my opinion...but if there is new technology that may offer a better chance of saving my husband's life, you better believe he should be able to get it and the insurance company/provider should not deny it.

I also believe people can not understand what it's like to face a life threatening illness....until the diagnosis is told to them.
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Old 05-30-2011, 10:00 PM   #13
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Glad to hear of your wife's experience here, Ed. Close call.

I have a similar quibble with the idea that digital mammograms are no better for older women than film ones that I have about the colonoscopy article.

I imagine the issue is the density and granularity of breast tissue, which is generally lower in post menopausal women. But not always, and IMO this is the rub with these kinds of articles. The average finding is just an average, but reality is composed of all sorts of women with all sorts of breast densities.

But in their zeal to cut costs public health authories and media can make a lot of mistakes that harm people. Especially when their knowledge is not particularly sophisticated.

Ha
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Old 05-30-2011, 10:18 PM   #14
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... fecal occult blood testing (FOBT) ...
It's inexpensive, easy, and a good initial screening tool.
Why do you say it's "a good initial screening tool"?
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Old 05-30-2011, 11:21 PM   #15
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I know for a fact that offices are "looking" for additional ways to bill more. Our friend who works for a group of cardiologists (aka old, worn out heart docs and mostly Medicare paid, like 80%). When Medicare cut many payouts, she found a used machine that does (I think) body scans of some sort because Medicare payed more for this type vs. the old machine they had (which had just been cut).

I really like her, but her story kinda ticked me off just on the morality of it. She blamed it on the docs pay reduction from $500k to $300k and needed to get it back up...

my .02
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Old 05-31-2011, 07:17 AM   #16
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I read the article and I am unimpressed. Basically, it says who cares if a 75 year old has colon cancer, he or she will likely die of something else before they can log another 8 years.
First question what are the odds of a 75 year person will die from colon cancer?

From the book "Know your Chances"
The numbers below tell you how many out of 1,000 will die from colon cancer in the NEXT 10 YEARS.
75 yr old male non smoker:13
75 yr old male smoker:11
75 yr old female nonsmoker:10
75 yr old female smoker:9

Second question how reliable are colonoscopies in discovering all polps & ademonas?

Reliability of results of a study done on colonoscopies in the book " Worried Sick".

"One study recuited 183 patients with positive FOBT to undergo 2 colonoscopies by 2 different experienced colonoscopists on the same day. The first colonoscopist removed all polps and adenomas that were discovered, 289 in all. The second found another 89 that the first missed."

The above answers may or may not effect a person's decision on the value of a colonoscopy. One of course should also consider one's family history of colon cancer.
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Old 05-31-2011, 07:27 AM   #17
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I know for a fact that offices are "looking" for additional ways to bill more. Our friend who works for a group of cardiologists (aka old, worn out heart docs and mostly Medicare paid, like 80%). When Medicare cut many payouts, she found a used machine that does (I think) body scans of some sort because Medicare payed more for this type vs. the old machine they had (which had just been cut).

I really like her, but her story kinda ticked me off just on the morality of it. She blamed it on the docs pay reduction from $500k to $300k and needed to get it back up...
This reminds me of a section in the book "Overtreated".
I'm paraphrasing. The federal government spent massive amounts of dollars to increase the supply of doctors to reduce health care costs. The number of medical school graduated doubled from 1960 to 1980. Physicians response? Doctors did not slash fees to attract more patients. They simply gave more medical care to their patients. Also the increased number of doctors drove doctor toward specialization & higher fees. Doctors are capitalists. Did the federal government did not consider that their actions would modify physician behavior?
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Old 05-31-2011, 08:48 AM   #18
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Why do you say it's "a good initial screening tool"?

Because when done annually after age 50, it has about the same diagnostic results as the colonoscopy done every 5 years. People with positive results from the FOBT need follow-up with a colonoscopy in order to investigate and remove polyps that are 5-10mms in size.

A colonoscopy will involve removing the polyps that are visualized, and it's acknowledged that it is not unusual to miss some. As with pretty much of medicine, it's a hit-or-miss approach at best.

Both of these issues, as well as the cost and the better chance for compliance because of the ease in doing a FOBT, make this a good initial screening tool.
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Old 05-31-2011, 10:35 AM   #19
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Originally Posted by GregLee
Why do you say it's "a good initial screening tool"?

Because when done annually after age 50, it has about the same diagnostic results as the colonoscopy done every 5 years.
The article you referenced doesn't say this. It says:
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No studies have directly compared colonoscopy with fecal occult blood testing (FOBT)
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Old 05-31-2011, 03:22 PM   #20
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GregLee:

There have been studies more recent then the 2005 article I referenced that do compare the two and find that patient outcomes are similar.

While I search for those, I've attached the physician guidelines for colon cancer screenings from the American Cancer Society published in 2008, which include FOBT as a screening option.


Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology -- L

The guidelines state:
"Although screening tests for CRC vary in terms of the degree of supporting evidence, potential efficacy for incidence and mortality reduction, cost-effectiveness, and acceptability, any one of these options applied in a systematic program of regular screening has the potential to significantly reduce deaths from CRC."

Some of the efficacy of FOBT relates to being noninvasive, with people more likely to perform the screening even when they have declined a colonscopy. The success of all diagnostic procedures, and obtaining results, depend on individual's willingness to have the screening done. It's a cost-effective tool in healthcare, which is why I mention it in this thread.
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