Healthcare Roundup: Health experts urge a payment overhaul

As the Obama administration struggles to keep employers from dropping coverage because of healthcare reform's new mandates, a slew of new reports this week examine ways to keep costs down.

Healthcare payment overhaul urged: Experts featured in the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey say they want to replace the current method of negotiating healthcare payments with individual doctors and hospitals. They would prefer a government authority to set the rates, or an all-payer system of jointly negotiating rates for all payers. Only 9 percent of survey respondents were in favoring of maintaining the current system. 

Opinion leaders also voiced broad support for creating a standard method of rewarding quality and efficiency across private insurers and public payers. More than seven of 10 said they felt it was important for all payers to use the same basic method of rewarding providers, which may be an effective way of improving patient outcomes, reducing wasteful administrative expenses and lowering costs.

"The way we currently pay for healthcare leads to unnecessary confusion and wide variation, and sometimes borders on chaotic," explains Commonwealth Fund President Karen Davis. "Experts agree that if private payers and public programs could come together and agree to pay the same way, and the same amount, we can improve the efficiency of our health care system, eliminate administrative waste, and create better experiences for patients." http://bit.ly/a5EIkh

Primary care undervalued: Researchers at U.C. Davis have put a price tag on just how little the U.S. values its primary care doctors. A national study of physician wages finds that specialists are paid as much as 52 percent more than primary-care doctors, even though they see far fewer patients. The difference adds up to millions of dollars over a career and contributes to skyrocketing healthcare costs, as society puts a premium on expensive procedures over basic health.

By comparing wages of more than 6,000 doctors practicing in 41 specialties in 60 communities, researchers came up with these figures: 

• Primary care, including pediatrics, geriatrics, family practice and internal medicine: $60.48 per hour;

• Internal medicine and pediatric subspecialties, including allergy and immunology, gastrointestinal, cardiovascular, rheumatology, pulmonary, critical care, medical oncology and neonatal: $84.85 per hour;

• Other medical specialties, including radiation oncology, physical medicine and rehabilitation, emergency medicine, psychiatry, neurology, ophthalmology and dermatology: $88.08 per hour;

• Surgery, including neurological, plastic, orthopedic and obstetrics/gynecologic: $92.10 per hour.

States can't afford Medicaid expansion: The healthcare reform law's expansion of Medicaid will bankrupt many states, the conservative National Center for Policy Analysis says in a new report. The brief looks at several factors — the cost of enrolling the already eligible, low Medicaid provider payments, lower payments for safety net hospitals and a crowd-out of private insurance — and concludes that states will find their share unaffordable, with reform costing Texas $27 billion through 2023. http://bit.ly/cbk0KQ

Twitter for your health: Social networking tools can drive down healthcare costs, the Healthcare Performance Management Institute says in a new study. The report provides several case studies that examine how patients and doctors are collaborating online in order to improve health outcomes and cut costs by as much as 20 percent. http://bit.ly/bVJQd1

FDA stifles innovation: Conflict-of-interest rules at the Food and Drug Administration are stifling the development of new drugs and devices, argues the free-market Manhattan Institute in a new report. http://bit.ly/9w78ss

Unintended consequences identified include:

• The FDA requires the public disclosure of the financial ties and payments of potential experts for its drug approval committees. The result: Nearly one-third of all drug approval committees remain unfilled; 

• The National Institutes of Health (NIH) forbids any communication between its scientists and scientists working in the private sector. The result: Premier experts in both sectors are denied the free exchange of ideas essential to medical innovation;

• Prominent medical societies restrict their physician members from accepting fees from pharmaceutical companies for participation in presentations marketing new drugs. The result: Experts in the field are unable to help new drugs come to market, even though studies and reports are presented to knowledgeable and skeptical audiences;

• Two Harvard-affiliated hospitals now monitor the per diem compensation their physicians receive for service on corporate boards. The result: Physicians devote less time to their hospital duties;

• Massachusetts enacted legislation that prohibits all physician gifts from pharmaceutical companies and medical device companies, including training sessions. The result: The Pharmaceutical and Medical Device Manufacturer Conduct Act forces valuable training and other vocational activities out of the state.

New role for FDA? The Mercatus Center at George Mason University hosts an event today titled "A New Role for the FDA to Make Food Safer." Director of Policy Research Richard Williams will discuss how the Food and Drug Administration has been using the same tools, regulations, and inspections to make food safer over its 104-year history. While there were some early achievements, he argues, these tools are no longer effective at making food-quality reliable. http://bit.ly/c4n8pM

Dental therapists provide answers: Dental therapists, despite getting only two years of intensive training, are providing "safe, competent, appropriate care" to underserved populations according to a new assessment of a pilot program in Alaska. The pilot could be replicated across the country as states grapple with ways to expand the reach of dentists to the 50 million Americans who lack access, particularly in rural and underserved areas. http://bit.ly/b5vPiV

What's next in Ohio? The anti-abortion rights group Susan B. Anthony List vowed to continue fighting after a federal judge in Ohio declined Monday to hear the SBA's challenge against that state's law against "false statements." A hearing has been scheduled for Thursday on the anti-abortion-rights group's ads against incumbent Rep. Steve Driehaus (D-Ohio). http://bit.ly/c5gTV6