Viewpoints: 'Sham Surgery' for research; bigger hospitals may not bring better care

Feb 20 2014

The Wall Street Journal: The FDA Wants You For Sham Surgery
In a landmark study of a new cardiovascular device unveiled last month, patients received anesthetics, had a large-bore catheter inserted through a cut into one of their major arteries, and had dye injected into their bloodstream. Their surgeons worked on them for about an hour, with unnecessary pokes and prods, while a monitor displayed the false progress using radioactive fluoroscopy. ... They were placebos. Was their sacrifice worth it? That is a question many patients may want to consider as the FDA insists on a new study methodology with uncertain benefits (Scott Gottlieb, 2/18). 

Bloomberg: Bigger Hospitals Mean Higher Prices, Not Better Care
Hospitals are busily merging with other hospitals and buying up groups of doctors. They claim that size brings efficiency and the opportunity to deliver more "value-based" care -- and fewer unnecessary services. They argue that they have to get bigger to cut waste. What's the evidence that bigger hospitals offer better value? Not a lot (Shannon Brownlee and Vikas Saini, 2/18).

The New York Times' Economix: The Employer Mandate: Dukakis All Over Again
Last week's adjustment to the employer mandate represents another battle in the political war of attrition between employers and those who want to carry out the federal health reform law. A similar war was fought in Massachusetts in the years after the Michael Dukakis administration and continued for decades (Casey B. Mulligan, 2/19). 

Los Angeles Times: Restaurant's Health Care Surcharge Draws Strong Responses
I had breakfast at Republique on La Brea Avenue on Tuesday, and here's how the tab broke down: Cafe Americano -- $3.25; Quiche -- $5; Tax -- 0.77; Surcharge Healthy LA -- 0.25. The last item is the one creating a little controversy at the new high-end restaurant in the old Campanile space. The owners are adding a 3 percent fee to every bill, which they say will pay for health care insurance for all their employees, from hostesses and bartenders to dishwashers and potato peelers (Steve Lopez, 2/18).

Politico Magazine: Bushcare
The Congressional Budget Office's warning that the Affordable Care Act will cause employment to fall by the equivalent of 2.5 million full-time workers is just the latest of Obamacare's negative surprises. Unfortunately, House Minority Leader Nancy Pelosi's statement that "we have to pass the bill so that you can find out what is in it" is proving to be depressingly accurate. The law's defenders legitimately argue that it is not sufficient merely to criticize the Affordable Care Act; responsible action requires proposing an alternative. Fortunately, Republicans have a good one, and it's been hiding in plain sight for the past seven years (Edward Lazear, 2/18). 

The Wall Street Journal: Fixing The 'Doc Fix'
Still no apparitions of the Lady of Fátima, but health-care leaders in both parties are trying to repeal the phony Medicare payment scheme that has abetted a decade of budget dishonesty. What a pity other precincts in both parties are conspiring to defeat this political miracle. Earlier this month the six Chairmen and Ranking Members of the committees with jurisdiction over Medicare released a bill that would permanently end the "sustainable growth rate," or SGR, the automatic formula that says doctor payments will be cut by 25 percent in April. The Senate Finance, House Ways and Means, and Energy and Commerce folks don't agree on much, but they're doing a service by agreeing to end this charade (2/18). 

JAMA: Public Disclosure Of Medicare Payments To Individual Physicians
Public disclosure of individual physician payment data has been advocated as a powerful tool to control health care costs and to improve the delivery of care -- and criticized as invading clinicians' privacy. The Centers for Medicare & Medicaid Services (CMS) recently announced that it would modify its long-standing policy to routinely deny requests for the disclosure of the amounts that had been paid to individual physicians under the Medicare program. ... the CMS announcement may also foreshadow even greater public access to individual physician payment data. Mandatory public disclosure of Medicare claims data is a provision of the bipartisan legislation in Congress to "fix" the sustainable growth rate formula used in calculating physician payments. If the provision becomes law, extensive Medicare claims data would be available to the public (Dr. Robert Steinbrook, 2/17).

JAMA: Beyond ACOs And Bundled Payments: Medicare's Shift Toward Accountability In Fee-for-Service
For all the attention paid to accountable care models, few observers have recognized that Medicare is rolling out the core framework of bundled payments within the hospital fee-for-service payment system. Under its hospital value-based purchasing ... program, Medicare has established the Medicare Spending Per Beneficiary (MSPB) metric, defined as the average Medicare Part A and Part B spending per patient (eg, all traditional Medicare fee-for-service spending outside of prescription drug coverage) from 3 days prior to admission to 30 days after discharge .... the significant majority of health care dollars still flow through fee-for-service; only about 10 percent of Medicare beneficiaries receive care through accountable care organizations (ACOs) .... By defining care bundles within traditional Medicare, MSPB brings the concept of accountability to full scale (Christopher Chen and Dr. D. Clay Ackerly, 2/19).