CBO Reveals Winners, Losers In Senate Health Care Plan : Shots - Health News : NPR

What you should know about the House and Senate bills to repeal/amend the Affordable Care Act.  

CHART: CBO Weighs Who Wins, Who Loses With Senate Health Care Bill

The nonpartisan Congressional Budget Office weighed in on the Senate health care bill on Monday, saying that 22 million people would lose health coverage in the next 10 years under the Senate's plan. Of those, 15 million would lose Medicaid coverage. It's projected to lower the deficit by billions over 10 years, and also cut taxes on corporations and the wealthy.

Medicaid covers low-income people including children, pregnant women, older people in nursing homes and the disabled. Under the Affordable Care Act, the federal government offered subsidies to help states to cover more people, though 19 states chose not to accept the federal money.

For individuals who purchase health coverage on the exchanges, the CBO says prices will vary — some will see lower premiums, especially in states that opt out of some consumer protections, which will allow insurers to sell plans that offer fewer benefits. However, for people would like to purchase plans that cover the essential health benefits mandated by the Affordable Care Act, including mental health coverage, addiction treatment, maternity care and prescription drug coverage, costs could go way up.

Other provisions in the Senate proposal would reduce subsidies and cause out-of-pocket costs to rise, the CBO says. As a result, starting in 2020, "despite being eligible for premium tax credits, few low-income people would purchase any plan."

AFFORDABLE CARE ACT (OBAMACARE)

Can get insurance through a parent’s plan or buy independently.

HOUSE BILL: AMERICAN HEALTH CARE ACT

Stays the same.

SENATE DRAFT: BETTER CARE RECONCILIATION ACT

Stays the same.

Adults under 65

AFFORDABLE CARE ACT (OBAMACARE)

Can buy insurance on health exchanges, with tax credits and subsidies if they meet income requirements up to 400 percent of poverty level. Cost of insurance is based on tobacco use and age, with the people nearing 65 paying no more than three times what the youngest pay. Premiums can’t cost more than 9.5 percent of income. Those with very low or no income qualify for Medicaid.

HOUSE BILL: AMERICAN HEALTH CARE ACT

Will see tax credits to pay premiums based on age, not income, and that max out at $4,000, much less than under the ACA. The oldest people under 65 can be charged five times more than the youngest, and maybe more depending on state rules. Medicaid cut after 2020.

SENATE DRAFT: BETTER CARE RECONCILIATION ACT

The CBO report says 22 million people would lose health insurance over the next 10 years, with people between 50-64 disproportionally impacted. The oldest people under 65 would pay five times more than younger people on the exchanges. Subsidies to help pay for insurance would be less and end at incomes of 350 percent of poverty level. Federal contributions to Medicaid start to decline in fiscal year 2020.

Low-income nursing home residents

AFFORDABLE CARE ACT (OBAMACARE)

Skilled nursing care covered by Medicare up to 100 days. Medicaid is available based on income.

HOUSE BILL: AMERICAN HEALTH CARE ACT

Skilled nursing care covered by Medicare up to 100 days. Medicaid services could be cut as states see federal funding decline.

SENATE DRAFT: BETTER CARE RECONCILIATION ACT

Skilled nursing care covered by Medicare up to 100 days per illness. Medicaid coverage for nursing home services could be cut as federal payments to states decline.

People with pre-existing medical conditions

AFFORDABLE CARE ACT (OBAMACARE)

Coverage cannot be denied or cost more.

HOUSE BILL: AMERICAN HEALTH CARE ACT

States can get permission to let insurers charge more for some pre-existing conditions and to exclude some people altogether. States would have access to federal money to help those with expensive policies or conditions.

SENATE DRAFT: BETTER CARE RECONCILIATION ACT

Insurance companies would be required to accept all applicants regardless of health status. But the draft bill lets states ask permission to reduce required coverage, also called “essential health benefits,” which would give insurers some discretion over what they offer in their plans. That could result in “substantial increases” in costs for people who want those services, according to the CBO. Caps on annual and lifetime spending by patients would no longer apply if the benefit is no longer classified as essential.

People who go to Planned Parenthood

AFFORDABLE CARE ACT (OBAMACARE)

Federal programs reimburse for most Planned Parenthood services.

HOUSE BILL: AMERICAN HEALTH CARE ACT

A one-year block will be placed on federal reimbursements for care provided by Planned Parenthood.

SENATE DRAFT: BETTER CARE RECONCILIATION ACT

A one-year block will be placed on federal reimbursements for care provided by Planned Parenthood. The CBO estimates 15 percent of women would lose access to family planning care, increasing birth rates and Medicaid spending for childbirth and children’s insurance. But those increases would be offset by Planned Parenthood cuts.

People with disabilities

The majority of Medicaid dollars go to people with disabilities.

AFFORDABLE CARE ACT (OBAMACARE)

May qualify for Medicare and also Medicaid.

HOUSE BILL: AMERICAN HEALTH CARE ACT

Services covered by Medicaid could be cut as federal funding to states declines over time.

SENATE DRAFT: BETTER CARE RECONCILIATION ACT

Services covered by Medicaid could be cut as federal funding to states declines over time. The CBO report suggests that by 2026, Medicaid enrollment would fall by more than 15 million people.

People who use mental health services

AFFORDABLE CARE ACT (OBAMACARE)

Covered by all plans under essential health benefits.

HOUSE BILL: AMERICAN HEALTH CARE ACT

Could lose coverage in states that get waivers from covering essential health benefits.

SENATE DRAFT: BETTER CARE RECONCILIATION ACT

States could request waivers to opt out of requiring essential health benefits. If a state opted out of coverage for mental health care, the CBO says insurance that includes mental health care coverage could become “extremely expensive.”

Either plan leads to reduced access to plans for patients. Medicaid plans would be impacted.

CBO Reveals Winners, Losers In Senate Health Care Plan : Shots - Health News : NPR

The U.S. Senate has drafted it's own version of the Affordable Care Act,   The Senate bill, called the Better Care Reconciliation Act (BCRA), also would reduce the federal deficit by $321 billion over the next 10 years, $202 billion more than what the House bill would save, the CBO said in a report released today. 

Senate Bill Replacing ACA Leaves 22M More Uninsured, CBO Says.

The House of Representative formulated it's own bill, The American Health Care Act.  U.S. President Donald Trump on Tuesday backed a draft Republican proposal to dismantle Obamacare that was unveiled Monday, saying the proposed healthcare legislation was "out for review and negotiation."

Trump, in a tweet on Tuesday morning, described the bill proposed by fellow Republicans in the House of Representatives as "Our wonderful new healthcare bill."

The plan, released late on Monday, would undo Democratic President Barack Obama's 2010 healthcare law, removing the penalty paid by Americans without insurance coverage and rolling back extra healthcare funding for the poor.

The plan was swiftly criticized by Democrats.

Although Obamacare has long been a common target of Republicans, the proposal also met with skepticism from some in the party who are concerned about the replacement plan's tax credits for buying health insurance and changes to coverage under Medicaid, the government health insurance program for the poor.

The plan must pass both the Republican-led House of Representatives as well as the Senate, where it faces a higher bar for passage, making its future uncertain.Both bills address cost saving as compared to the original affordable care act.  Neither addresses insuring the uninsurable or pre-existing clauses for denial of insurance coverage.

The BCRA has already been panned by major medical societies for reducing healthcare coverage, particularly in the Medicaid program. One of the most strongly worded criticisms from organized medicine came today from the American Medical Association (AMA). In a letter to the US Senate, AMA Executive Vice President and CEO James Madara, MD, said the BCRA in many ways violates the physician's imperative of "first, do no harm".

"We believe that Congress should be working to increase the number of Americans with access to quality, affordable health insurance instead of pursuing policies that have the opposite effect," Dr Madara wrote.

Neither House or Senate Bill prioritizes patient access or quality of care. It is more about budgetary requirements.  Patients seem to be a side issue.

Senate Bill Replacing ACA Leaves 22M More Uninsured, CBO Says

Fitbit eyes sleep apnea space for next digital innovation | MobiHealthNews

Sleep apnea is not a benign problem. People who are overweight, loud snorers and even normal people can be at high risk of sleep apnea.

Sleep apnea is correlated with higher risks of hypertension, stroke, and sudden death. Sleep apnea causes poor sleep, chronic fatigue by interrupting normal REM sleep.

Normally most patients are referred to specialty sleep labs for testing.  This entails an overnight stay where  blood oxygen saturation levels, movement, and respirations are measured.  The recordings are reviewed by a physician.

If sleep apnea is diagnosed a CPAP device may be recommended while sleeping.

Fitbit has made increasingly targeted moves to wedge itself deeper into the healthcare ecosystem. No longer able to rely on the consumer market alone to stay financially healthy, the company has continually upped the ante to prime itself as a digital health company in its own right.

There have been many efforts as of late, including developing more sophisticated wearables to enable tracking of more varied biometric data, participating in a large amount of clinical research, making itself a regular fixture in many corporate wellness programs and merging their digital health and enterprise health sectors into one. And now, as CNBC reports, the company is working to make itself a part of the booming “sleep tech” market by developing tools to help diagnose and monitor sleep apnea, a common condition that is marked by shallow breathing and pauses in respiration during sleep.  

While it isn’t yet known exactly what form that will take, Fitbit already has much of the technological capabilities to start building such a device. Conor Heneghan, the company’s lead research scientist told CNBC they are exploring the use of heart rate monitoring and optical technologies to track changes in oxygen levels. By shining a light into the skin, the technology can detect the difference between highly oxygenated red blood and that which is more blue due to less oxygen saturation. If the levels fluctuate during the night, it could indicate sleep apnea. 

"We'd perform a useful public service by alerting users to the fact that they have a problem," Heneghan told CNBC.

It’s obvious why Fitbit, which has suffered declines in sales and products shipped in the last few quarters, would want to get into sleep tech. The space has been heating up for the last year, and it was decreed the hottest topic at CES 2017. Even Apple is betting on it, with the acquisition of Beddit in May. The market for sleep apnea is expected to hit $6.7 billion in the next four years, and many digital health companies such as ResMed have enjoyed considerable success with their connected, medical-grade devices to diagnose and treat the condition.

It’s also unknown whether Fitbit would seek to develop a diagnostic device, one that works as a prompt to get people to seek medical attention. Additionally, they could be working on something that monitors treatment adherence and effectiveness, and any such device would require different regulatory pathways.  

Heneghan told CNBC Fitbit is currently working with sleep labs to learn how prototypes to detect sleep apnea are performing. If they can develop a device that stands up to accuracy standards of existing sleep apnea-detecting tests and devices (digital or otherwise), the company expects to bring a product to market within a year.  

It may be some time until this device is on the market. It will require FDA approval as a medical device.

Fitbit eyes sleep apnea space for next digital innovation | MobiHealthNews

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The Real 13 Senators to Watch on Health Care

The Real 13 Senators to Watch on Health Care

How Data Mining Facebook Messages Can Reveal Substance Abusers -

Substance abuse changes people’s patterns of behavior, and this is detectable in their social media messages, say researchers.

• by Emerging Technology from the arXiv
 
• May 26, 2017

“A substance use disorder (SUD) is a condition in which recurrent use of substances such as alcohol, drugs and tobacco causes clinically and functionally significant impairment in an individual’s daily life.” So begin Warren Bickel from the Addition Recovery Research Center in Roanoke, Virginia, and a couple of pals, who study this condition.

Substance abuse is a serious concern. Around one in 10 Americans are sufferers. Which is why it costs the American economy more than $700 billion a year in lost productivity, crime, and health-care costs. So a better way to identify people suffering from the disorder, and those at risk of succumbing to it, would be hugely useful.

Bickel and co say they have developed just such a technique, which allows them to spot sufferers simply by looking at their social media messages such as Facebook posts. The technique even provides new insights into the way abuse of different substances influences people’s social media messages.

The new technique comes from the analysis of data collected between 2007 and 2012 as part of a project that ran on Facebook called myPersonality. Users who signed up were offered various psychometric tests and given feedback on their scores. Many also agreed to allow the data to be used for research purposes.

One of these tests asked over 13,000 users with an average age of 23 about the substances they used. In particular, it asked how often they used tobacco, alcohol, or other drugs, and assessed each participant’s level of use. The users were then divided into groups according to their level of substance abuse.

The results make for interesting reading. The team says its technique was hugely successful. “Our best models achieved 86%  for predicting tobacco use, 81% for alcohol use and 84% for drug use, all of which significantly outperformed existing methods,” say Bickel and co.

The technique also identified a wide range of keywords that people with substance abuse disorder are more likely to use in social media posts. “Swear words such as ‘fuck’ and ‘shit,’ sexual words such as ‘horny’ and ‘sex,’ words related to biological process such as ‘blood’ and ‘pain’ are positively correlated with all three types of substance use disorder,” say Bickel and co, referring to tobacco, alcohol and drug use. “In addition, female references such as ‘girl’ and ‘woman,’ prepositions, space reference words such as ‘up’ and ‘down’ are positively correlated with alcohol use, while words related to anger such as ‘hate’ and ‘kill,’ words related to health such as ‘clinic’ and ‘pill’ are positively correlated with drug use.”

That’s interesting work that immediately suggests a way to identify people who are at risk of substance use disorder—simply look at their Facebook posts and likes. “We believe social media is a promising platform for both studying SUD-related human behaviors as well as engaging the public for substance abuse prevention and screening,” say Bickel and co.


How Data Mining Facebook Messages Can Reveal Substance Abusers - MIT Technology Review

Washington's Princes of Paperwork Are Crushing Physicians and Bankrupting, If Not Killing, Patients

Totally neglected in the ACA and proposed AHCA is restricting the mounting paperwork burden placed on providers. This is a critical issue.  Each "improvement" which is proposed to increase quality of care, or reduce cost creates a paradoxical effect.  This is the reduction in patient care, increased non clinical paperwork and the addition of EHR and other HIT cost.

This issue must be addressed in any new health reform law.

Steve Hanke ,  

 CONTRIBUTOR

I cover economics and finance.  

Opinions expressed by Forbes Contributors are their own.

Thomas Eakins

The Agnew Clinic (1889).

In the rancorous to and fro over the repeal of ObamaCare and its possible replacement with the American Health Care Act, an elephant in the room has remained unnoticed. It’s that giant bundle of burdensome regulations that is crushing physicians, their staffs, and sending the costs of healthcare soaring.

A recent, detailed study published by the American Medical Association (AMA) sheds a common-sense light on what Washington chooses to ignore. For every hour physicians spent with patients, almost two additional hours are spent pushing papers. Even when face-to-face with patients, doctors spent 37% of their time filling out forms.

Burdened with the weight of regulatory paperwork, doctors are becoming increasingly unhappy – more paperwork, less time with patients. Indeed, in a typical day, during office hours, doctors spent only 27% of their time attending to patients face-to-face and 49.2% on electronic health records (EHR) and desk work. Even during after-hours work, doctors spent a whopping 59% of this time dealing with electronic health records.

The following table summarizes the AMA’s stunning findings. It tells the red-tape tale in horrifying detail.

Just why do regulators promulgate so many regulations and produce so much red tape? For one thing, it creates jobs for the boys (read: the Princes of Paperwork). There is no better bulletproofing for a bureau’s bloated budget than a complex maze of regulations that “must” be enforced to protect the public’s health and safety.

But, there is another, perhaps more important, reason why regulatory bureaus produce endless miles of red tape to wrap around doctors, medical staffs, and the U.S. healthcare system. Bureaucrats are conservative. They like to avoid risks, and decision making is an inherently risky activity. After all, decisions can prove to be wrong, unpopular, or both. So, to avoid the risks and responsibilities that come with discretion and decision making, regulators produce rigid rules and red tape – the more, the merrier. The regulators’ check-the-box mentality allows them to slip out from under any responsibility if something under their regulatory purview “goes wrong.” The regulators are protected, and the onus is placed on the doctors and their staffs who must check all those boxes – boxes that cover everything under the sun.

Washington's Princes of Paperwork Are Crushing Physicians and Bankrupting, If Not Killing, Patients

The Cover up of Health Care Provider Abuse.

Let's take a listen to ZdoggMD.  Zdogg is a physician who began Turntable Health in Las Vegas, as a unique direct payment model with a heavy emphasis on patient engagement and wellness.

Dr Z as he is well known also is an entertainer of some repute, with a considerable portfolio on his Youtube Channel.  His vignettes are at time serious but more often he addresses serious problems with a thick shellac of humor. Zdogg has given commencement addresses and is a nationwide speaker at medical meetings.

Here he take on the issue of dangerous assaults on first line responders, and nurses. In this case he elaborates on a case of a nurse being assaulted and raped, and the dereliction of duty by a correctional officer on the scene.  Listen to the horrific story.

It Is Time for Doctors to Fight Back

DesignPrax/Shutterstock.com

Recently a featured post on Doximity, a professional closed physician social media web site an article appeared, " Is it Time for Doctors to Fight Back?"

Matthew Hahn, MD · May 8, 2017

The American health-care system is broken, but it is not really “health-care” that is the problem. The science of medicine, the tests, and the treatments available are better than ever. It is health-care bureaucracy that is the problem. But doctors, nurses, and patients bear the brunt of the dysfunction. Medical professionals are unable to practice, and patients are denied the care they need, even though it is readily available. Careers are being ruined, and lives lost along the way. It is time to fight back.

Instead of focusing on ways to improve patient care, medical professionals today have to wade all day through a jungle of red tape just to get paid, order tests, and deliver treatments. Cumbersome government rules control the details of how we write notes, use a computer, calculate a bill, how much we can charge, who we can admit to the hospital, how long we can treat them, and much, much more.

And for everything we do, there must now be data. The bureaucracy is obsessed with data, to the detriment of everything else. It is tyranny through data. We spend so much time collecting data and running after all of these things that it is a challenge to find the time to actually care for patients! On top of that, newer health insurance policies with high premiums, high deductibles, prior authorizations, and narrow, inscrutable coverage block us from delivering the care patients need. It is health care by government and insurance company fiat. Medical professionals and patients have few choices and little control.

And now, on top of everything else, we face Medicare’s complicated new MACRA “value-based payment” program, which collects data across four categories: Quality Measures, Advancing Care Information, Performance Improvement Activities, and Cost. A physician’s annual score will be compared to the scores of other physicians to determine future Medicare pay increases or penalties. There is a huge effort being made to explain the intricacies of the new program, the first sign that it is too 

And for everything we do, there must now be data. The bureaucracy is obsessed with data, to the detriment of everything else. It is tyranny through data. We spend so much time collecting data and running after all of these things that it is a challenge to find the time to actually care for patients! On top of that, newer health insurance policies with high premiums, high deductibles, prior authorizations, and narrow, inscrutable coverage block us from delivering the care patients need. It is health care by government and insurance company fiat. Medical professionals and patients have few choices and little control.

And the sad fact is that none of this data and/or analytics has been shown to improve care or costs. Most studies have been poorly designed, and never been confirmed.

For those of you wish to dive more deeply into . Medicare, MACRA, and other regulatory issues click on these links:

And now, on top of everything else, we face Medicare’s complicated new MACRA “value-based payment” program, which collects data across four categories: Quality Measures, Advancing Care Information, Performance Improvement Activities, and Cost. A physician’s annual score will be compared to the scores of other physicians to determine future Medicare pay increases or penalties. There is a huge effort being made to explain the intricacies of the new program, the first sign that it is too complicated to be of benefit.

It Is Time for Doctors to Fight Back

More and more physicians are no longer sitting by and allowing administrators to devalue patient care and set artificial metrics for quality of care.  Quality of care now, is measure by the number of boxes checked of in an electronic health records.  Simplistic measures such
Sickcare is sick and innovation can help make it more like a healthcare system. Forces are already in play making that happen, but it will take a substantial effort still to achieve a more cost-effective, user friendly and efficient system. Overcoming the political, economic and cultural barriers of government, academia, business and sick care is indeed a Herculean task. 

Trump's policies are pressing doctors to speak out

ACA repeal efforts and other Trump administration policies are getting unprecedented pushback from the medical community.A lot is on the line. The House has passed legislation to replace the ACA in the American Health Care Act (ACHA), and the Senate is working on its own repeal bill. Funding for women’s health programs and protections for people with preexisting conditions are at risk of being cut or eliminated. The president’s budget would slash Medicaid by more than $600 billion. And Trump’s executive order on immigration threatens to curb the supply of foreign doctors.Doctors are speaking out against the administration's policies in public media, in protests, through petitions and in direct conversations with lawmakers, either in Washington or during town halls in their districts. For the most part, their employers support them. Doctors are careful to separate their patient contact from their political activity, but many view protesting as not only a right, but also an obligation.

In an opinion piece in the Washington Post, Dr. Dhruv Khullar urged Congress and the White House to ensure that no one with health insurance today would lose coverage in the future. “My patients can’t wait for policies that appeal to this political lobby or that political base,” he wrote. “Any lapse in insurance coverage affects the care they get — or don’t get — First do no harm

Doctors must toe a fine line in balancing political advocacy and their responsibilities to patients.

The American Medical Association’s (AMA) Code of Medical Ethics encourages doctors to “stay well informed” about proposed healthcare policies and “work toward and advocate for the reform and proper administration of laws related to healthcare.” However, it draws a line against mixing politics with patient care. According to Section 2.3.4, physicians should “be sensitive to the imbalance of power in the patient-physician relationship” and “refrain from political conversations during the clinical encounter.”

The American College of Physicians (ACP) encourages its members to take a stand on issues affecting healthcare. “We have been advocating very, very strongly in support of the ACA and against the AHCA,” Dr. Jack Ende, president of the ACP, tells Healthcare Dive, adding that the college focuses on policies and not political parties or politicians. “If the evidence shows that the public is better served with one program, that’s the program we support,” he says.There have also been turnouts at GOP town hall in support of the Affordable Care Act and callers expressing concerns about HHS Secretary Tom Price’s ties to healthcare companies. The public outcry puts businesses in a bind that ultimately just want to make money. Hospitals and health systems now have to consider their brand under the Trump administration.While health systems and other employers typically refrain from activism, most seem to support medical professionals’ right to protest policies they feel harm patients, so long a they do it on their own time.Care through a broader lens

For many physicians, the Trump era has sharpened the realization that staying in their office isn’t enough and that larger contextual issues play as important a role in a patient’s health as the treatments doctors prescribe.To influence the debate, Chhabra and some colleagues formed Clinician Action Network. The group now numbers about 70 physicians, many working in health policy and serving underserved populations, and studies the impact of policy decisions on patients to effectively advocate on their behalf. Obligation to speak out

Ende sees the increased activism as a reflection of a current trend to teach medical students and residents to be sensitive to problems in their workplace. If a hospital system doesn’t provide adequate nursing support or doesn’t address issues about patient experience, doctors have an obligation to speak out and try to push positive change. Speaking out on healthcare policies at the state and federal levels is a natural and logical extension of that trend.

If you are reading this and have not spoken out.  Do so now !  Call or email your congressman or senator. Better yet, visit them in person !

Trump's policies are pressing doctors to speak out | Healthcare Dive

How To Discourage a Doctor | THCB

I came across this series of articles and comments whilst researching for today's post.



The hospital is not a friend of the doctor. These stories will illuminate what many physicians face. Perhaps it is not a uniform policy, and perhaps the tide has turned with the battle being won by hospital conglomerates.  The days of the local community hospitals is about over, due to mergers and acquisitons forced by economic necessity and solvency.  For most of the hospitals who did not merge are now gone.

These are the daily battles that your physician(s) endured to care for patients. Shameful !  While there are many hospital executives that do not subscribe to these tactics a few bad apples spoil the barrel.

The details of the article are much too long to long to repeat here, these are some of the high points.

"Not accustomed to visiting hospital executive suites, I took my seat in the waiting room somewhat warily. That was when I spotted the document on an adjacent chair. Its title immediately caught my eye: “How to Discourage a Doctor.” No one else was about, so I reached over, picked it up, and began to leaf through its pages. It became apparent immediately that it was one of the most remarkable things I had ever read, clearly not meant for my eyes. 

My recollection of its contents is naturally somewhat imperfect, but I can reproduce the gist of what it said. “The stresses on today’s hospital executive are enormous. They include a rapidly shifting regulatory environment, downward pressures on reimbursement rates, and seismic shifts in payment mechanisms. Many leaders naturally feel as though they are building a hospital in the midst of an earthquake. With prospects for revenue enhancement highly uncertain, the best strategy for ensuring a favorable bottom line is to reduce costs. And for the foreseeable future, the most important driver of costs in virtually every hospital will be its medical staff.

“Though physician compensation accounts for only about 8% of healthcare spending, decisions that physicians strongly influence or make directly – such as what medication to prescribe, whether to perform surgery, and when to admit and discharge a patient from the hospital – have been estimated to account for as much as 80% of the nation’s healthcare budget. To maintain a favorable balance sheet, hospital executives need to gain control of their physicians. Most hospitals have already taken an important step in this direction by employing a growing proportion of their medical staff.

“Though physician compensation accounts for only about 8% of healthcare spending, decisions that physicians strongly influence or make directly – such as what medication to prescribe, whether to perform surgery, and when to admit and discharge a patient from the hospital – have been estimated to account for as much as 80% of the nation’s healthcare budget. To maintain a favorable balance sheet, hospital executives need to gain control of their physicians. Most hospitals have already taken an important step in this direction by employing a growing proportion of their medical staff.  “Merely controlling the purse strings is not enough. To truly seize the reins of medicine, it is necessary to do more, to get into the heads and hearts of physicians. And the way to do this is to show physicians that they are not nearly so important as they think they are. Physicians have long seen the patient-physician relationship as the very center of the healthcare solar system. As we go forward, they must be made to feel that this relationship is not the sun around which everything else orbits, but rather one of the dimmer peripheral planets, a Neptune or perhaps Uranus.

“How can this goal be achieved? A complete list of proven tactics and strategies is available to our clients, but some of the more notable include the following:

“Make healthcare incomprehensible to physicians. It is no easy task to baffle the most intelligent people in the organization, but it can be done. For example, make physicians increasingly dependent on complex systems outside their domain of expertise, such as information technology and coding and billing software. Ensure that such systems are very costly, so that solo practitioners and small groups, who naturally cannot afford them, must turn to the hospital. And augment their sense of incompetence by making such systems user-unfriendly and unreliable. Where possible, change vendors frequently.

“Promote a sense of insecurity among the medical staff. A comfortable physician is a confident physician, and a confident physician usually proves difficult to control. To undermine confidence, let it be known that physicians’ jobs are in jeopardy and their compensation is likely to decline. Fire one or more physicians, ensuring that the entire medical staff knows about it. Hire replacements with a minimum of fanfare. Place a significant percentage of compensation “at risk,” so that physicians begin
to feel beholden to hospital administration for what they manage to eke out.

“Transform physicians from decision makers to decision implementers. Convince them that their professional judgment regarding particular patients no longer constitutes a reliable compass.

“Subject physicians to escalating productivity expectations. Borrow terminology and methods from the manufacturing industry to make them think of themselves as production-line workers, then convince them that they are not working sufficiently hard and fast. Show them industry standards and benchmarks in comparison to which their output is subpar. On the off chance that their productivity compares favorably, cite numerous reasons that such benchmarks are biased and move the bar
progressively higher, from the 75th

“Increase physicians’ responsibility while decreasing their authority. “Above all, introduce barriers between physicians and their patients. The more directly physicians and patients feel connected to one another, the greater the threat to the hospital’s control.

How To Discourage a Doctor | THCB

A patient’s budding cortex — in a dish? | National Institutes of Health (NIH)

Frankenstein----in a petri dish

A patient’s budding cortex — in a dish? 

The modern version...Franken-dish does not have a bolt through it's head.

Budding brain-like “human cortical spheroids” growing in a petri dish. Sergiu Pasca, M.D., Stanford University

A patient tormented by suicidal thoughts gives his psychiatrist a few strands of his hair. She derives stem cells from them to grow budding brain tissue harboring the secrets of his unique illness in a petri dish. She uses the information to genetically engineer a personalized treatment to correct his brain circuit functioning. Just Sci-fi? Yes, but...

An evolving “disease-in-a-dish” technology, funded by the National Institutes of Health (NIH), is bringing closer the day when such a seemingly futuristic personalized medicine scenario might not seem so far-fetched. Scientists have perfected mini cultured 3-D structures that grow and function much like the outer mantle – the key working tissue, or cortex — of the brain of the person from whom they were derived. Strikingly, these “organoids” buzz with neuronal network activity. Cells talk with each other in circuits, much as they do in our brains.

Neurons and supporting cells in the spheroids form layers and organize themselves according to the architecture of the developing human brain and network with each other.Sergiu Pasca, M.D., Stanford University

Sergiu Pasca, M.D.(link is external), of Stanford University, Palo Alto, CA, and colleagues, debut what they call “human cortical spheroids,” May 25, 2015 online in the journal Nature Methods.

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A patient’s budding cortex — in a dish? | National Institutes of Health (NIH)