Evidence-Based Medicine in Theory and Practice

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  • 12/12/2007
More examples proving that managed care companies are run by people that could never run a real business...

The Wall Street Journal on Wednesday examined how hospitals have begun "taking steps to prevent the most common risk to patients after discharge: landing back in the hospital due to complications that could have been prevented with better follow-up care." According to the Journal, a "revolving door of readmissions is driving up costs for hospitals and causing needless harm to patients, especially elderly people with multiple chronic diseases."

Almost 18% of Medicare beneficiaries who are admitted to a hospital are readmitted within 30 days at a cost of $15 billion, according to the Medicare Payment Advisory Commission. As a result, "readmission rates are coming under increasing scrutiny from regulators, insurers, employers and quality-measurement groups, who are considering methods to tie payment to lower readmissions," the Journal reports.

The Institute for Healthcare Improvement has partnered with several hospitals to reduce readmissions through programs that identify patient risk for readmission, schedule follow-up visits with patients before discharge, send nurses on at-home visits to ensure patient adherence to medication regimens, monitor patients at home, and educate patients and families on adherence to medication and self-care regimens.

Most hospitals currently "don't provide such services" in part because they "aren't paid to coordinate care once a patient leaves," the Journal reports.

However, "that may change" as managed care companies and health insurers experiment with programs that cover the cost of coordination of patient care, according to the Journal. Randall Krakauer, medical director at Aetna, said, "We believe this can improve the quality of care for members and more than pay for itself by reducing the costs of care by a larger amount than the cost of the home visits" (Landro, Wall Street Journal, 12/12).

Don't hold your breath...

Here's how the biggest health plan in Rochester, NY -- along with the VA, a Hillary Clinton model of health care excellence, is now rationing care in penny-wise, pound foolish fashion....

Democrat and Chronicle, Dec. 12, 2007

Doctors seek fair role with Excellus

BY: Patrick Flanigan

Rochester-area doctors must work together and demand "a seat at the table" on the issue of balancing the need for expensive radiology exams with the need to control rising medical costs.

That was the message delivered Tuesday night to about 100 doctors and other medical professionals meeting at the Monroe County Medical Society to discuss a controversial radiology management program.

Excellus BlueCross BlueShield launched a program in October that requires doctors to obtain the insurance company's approval before scheduling exams such as PET scans, CT scans or MRIs.

Those exams, which diagnose conditions including cancer and heart disease, are among the most expensive procedures in modern health care.

Excellus officials have defended the program as a way to cut the rising cost of health care by asking doctors to be more judicious. The insurer spends about $560 million a year on radiology exams.

The doctors said Tuesday they recognize that costs are a problem. But in this case, they said, the quality of patient care is being threatened.

Dr. John Genier, president of the Rochester General Physicians Organization, said doctors must be participants in the discussion about the issue. He also urged his fellow physicians to keep the focus on their patients.

"It's easy to get angry. It's easy to insurance-bash. That will not benefit us," Genier said. "When you get frustrated and feel like you just can't beat a 700-pound gorilla, remember the patients."

Here's the rest of the story:


Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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