Saturday, June 20, 2009

An apple a day keeps the doctor away - but it will cost you!

On the heals of the Atul Gawande piece in the New Yorker, Dr. Abraham Vergese wrote an interesting cover article today in the Wall Street Journal on the Myth of Prevention. It is more of a thought piece then something that tries to make a clear and persuasive argument. The main point he tries to make is that “preventative medicine” promoting drugs and tests like coronary artery calcium scans won’t actually result in cost savings. Screening tests will only find conditions that will require further testing, retesting, and life-long therapies that may only benefit a small subset of patients (think PSAs in the elderly). He argues that the only way to control costs is by government wielding greater influence in health care. This is not a novel view point by any means but it is a stance that is a rarity to find in the Wall Street Journal.

 More intriguing though was a short discussion on how Medicare’s reimbursement scheme is partly to blame for what President Obama called “a system of incentives where the more tests and services are provided, the more money we pay." A system, as Dr. Vergese puts it, that “pays generously when you do something to a patient, but is stingy when you do something for a patient.” We all know interventions are the key to high reimbursement - not active case management or spending time with patients to find out their goals and values. A sustainable future for both geriatrics and palliative care may lie in correcting these incentives, or by learning how to do botox.

1 comment:

ken covinsky said...

Amen! Medicare is getting what it pays for.

The primary "procedure" of Geriatrics and Palliative Care is talking with our patients. Contrary to popular belief, doing this well is a complex "procedure" that takes time and skill. It is pretty striking how physicians who do this well make such a difference for their patients. It is not uncommon to see a care plan completely change based on a careful patient centered history. More often than not, this results in doing less TO patients, but doing a lot more FOR them.

Maybe one day Medicare will start viewing spending time with patients as something of value.