Health Business Blog

Health care business consultant and policy expert David E. Williams share his views

Surprise! Medicare spending estimate rises again

According to Modern Healthcare:

The Congressional Budget Office upped its 2006-15 Medicare spending estimate by $70 billion to about $5.5 trillion, primarily because of higher estimated costs under the new prescription drug benefit… The CMS recently estimated net federal spending on the benefit at $723 billion for 2006-15… Meanwhile, the agency said President Bush’s Medicaid proposals would yield smaller net savings than expected, $8.5 billion through 2010 instead of the $13 billion projected by the White House.

How soon until we see some serious efforts to use Federal spending power to negotiate for lower prices or impose price controls? If the pharma industry’s image continues to decline, whether because of safety issues, marketing practices, resistance to reimportation, or pricing increases, I predict we’ll see major pressure by the 2006 election cycle. It may start with “voluntary” controls on price increases to Medicare as Pharma sees the writing on the wall and gets nervous.

Interesting to see the President claim Social Security is going bankrupt while he simultaneously spearheads policies that threaten Medicare’s viability.

Followup on electronic communication between doctors and patients

After I posted Electronic communication between doctors and patients I learned a couple of interesting things:

Medpundit has signed up to use RelayHealth.

A source at RelayHealth pointed out that physicians and patients receive a benefit from the more thoughtful nature of sitting down to compose a message rather than trying to express one’s thoughts in a brief phone or in-person session:

The act of sitting down, logging in, selecting a webVisit, completing it, and reviewing their answers before the doctor ever sees it is comforting in a way to the physicians. They realize that patients don’t get much of an opportunity to convey a message – be it a 30 second voice mail or a hand written message on a pink message pad from a secretary, doctors are starting to truly get and appreciate that what we do is be better than what they’ve been doing for years.

Drug resistant HIV scare

Last month the New York City health department issued a press release entitled “New York City Resident Diagnosed with Rare Strain of Multi-Drug Resistant HIV that Rapidly Progresses to AIDS.”Major media picked up on the announcement as a watershed event that could mark a turn for the worse in combating the HIV/AIDS pandemic.

I asked Veronica Miller, PhD, Director of the Forum for Collaborative HIV Research for her view. Here’s what she had to say:

The case of the “new strain” of HIV has generated much interest and concern. Numerous previous studies have documented the transmission of resistant HIV, including resistance to one, two or three drug classes. While the findings reported recently are not “new”, the publicity has highlighted the need to pay attention to the spread of drug resistant HIV. It also highlights the need for a surveillance program to monitor drug resistance. We lack a true picture of resistant HIV in North America. Most of the information we have comes from small, specialized studies of non-representative populations. Surveillance of HIV drug resistance will provide crucial local, state, provincial and national data concerning the prevalence of drug resistance over time. It will enable public health officials, policymakers, and clinicians to recommend the appropriate use of drug resistance testing and the most efficient initial treatment combinations.

Air ambulances: costly, dangerous, slow?

According to today’s Wall St. Journal, not only are air ambulances liable to crash (a crew member who worked 20 hours/week for 20 years would have a 40% chance of being killed), they are often slower than ground ambulances, and are used to transport patients who aren’t that sick.

The conventional wisdom is that air ambulances save the lives of patients who are too critically ill to withstand a slower ride in a ground ambulance. Yet some observers of the industry say medical air transports actually save very few lives — while costing as much as 10 times more than ground ambulances. A number of published studies including research at Stanford University and the University of Texas, show that the flights often transport minimally injured patients when ground transport frequently could get them to a hospital faster, and with less risk to others.

“In 20 years of experience in urban critical-care helicopter transport, I can count on the fingers of one hand the number of times I thought flying a patient to the hospital made a significant difference in outcome compared to lights and siren,” says David Crippen, an associate professor of critical care and emergency medicine at University of Pittsburgh Medical Center.

Of course, there are situations where air ambulances make sense, such as in rural areas. On the other hand, even speedy air ambulances can’t do much about the 10-20 hours waits I mentioned in yesterday’s post on Mass General.

After 9-year-old Tyler Herman fell and broke his jaw in the wilds of Arizona, doctors at a community hospital decided the boy should fly to Phoenix to undergo plastic surgery for a gash on his face. During the flight he was well enough to sit up and remark on the scenery. Upon arriving in Phoenix, he waited nearly 20 hours to undergo surgery. “We could have driven him there in four hours,” says Sharon Herman, the boy’s mother. Her insurance didn’t cover air transport, leaving the Hermans with a bill for $25,000.