Monday, June 8, 2009

Creative Arguments from AdvaMed, AHIP, AHA, AMA, PhRMA and SEIU on Health Care Savings (and how to use their logic on the spouse)

As readers know, the Disease Management Care Blog (DMCB) is a unique mix of common sense, a primary care doctor’s perspective, experience in managed care, a track record of peer-review scientific publications and a working knowledge in disease management and the medical home that modestly offers up a daily assessment of happenings in the health care policy landscape. And each of those skills were necessary to review the June 1 ‘Dear Mr. President’ letter from AdvaMed, AHIP, AHA, AMA, PhRMA and SEIU on their prodigious promise to ‘transform the U.S. health care system.’

The DMCB is grateful to have access to this letter because it is thinking about joining a country club. Years ago, when it was in regular clinical practice, a mentor wisely observed that docs can be either a great golfer or a great physician, but never both. As a result, the DMCB’s handicap languished. It’s time to address that tragedy.

But, as regular readers may surmise, the tightfisted DMCB spouse is implacably opposed to this perfectly reasonable idea. Stymied by her merciless checkbook CBO-like logic, the DMCB’s health policy expertise has been of little help in formulating creative arguments to win her over. The ‘transform’ letter described above is a great resource for the kind of imaginative appeals that the DMCB needs in its country club campaign. Read on and learn, not only about this rather fanciful corner of health care policy, but how to win when it comes to using inventive budgeting to get your way.


Representing the medical device and remote monitoring industry, this group promises that overuse of their technology will reduce overuse of other medical care. While there is merit to the notion that earlier detection, greater accuracy and less human error in health care is important, the DMCB also knows that technology is the number one driver of health care costs.

The Country Club point of view? Yes, there’s a cost, but with the AdvaMed viewpoint, think of how much we’ll save on all those public course greens fees, gas, mileage, cart rentals and food. Fewer players on the course will also increase golfing efficiency, maximizing the tee to time-unit efficiency of the DMCB’s game. Likelihood of more golfing? We won’t mention that.


This health insurer group believes administrative simplification with automated claims submissions, eligibility confirmation, claims status inquiries and efficient payment will turn an arcane process into a nirvana of ATM-like convenience. They also want rely on web portals, pooling of physician quality measures, increasing health literacy and promoting personal health records. This will reduce their expense ratios that reduce those background administrative costs that the DMCB’s former patients and physician colleagues rarely ever complained about.

The Country Club point of view? Using AHIP logic, getting a tee time can be a challenge for a non-member, the golf cart on public courses are not outfitted with GPS’, the rough is rougher resulting in more lost balls and the greens are lacking the coded flags, reducing the likelihood of a two-putt. It’s time to make the play far more efficient than it already is. The fact that golf courses should be doing all this stuff already despite their pricey greens fees will also go unmentioned.

American Hospital Association

They’ve branded their efforts as the ‘Pursuit of Excellence Campaign’ that promises to reduce surgical, central line, methicillin resistant Staph, C difficile, ventilator associated pneumonia and catheter-related urinary tract infections as well as drug mishaps and pressure ulcers. They are also committing to better discharge planning, use of technology, hospice, fall prevention, better perinatal care and reduced supply costs and ultimately contributing to a ‘coordinated ecosystem’

The Country Club point of view? The DMCB really likes the AHA's creative verbiage. Accordingly, this is not about joining a country club, but a Pursuit of Contented Healthfullyness Campaign that will reduce the incidence of life-threatening stress in its own ‘fairwayed matrixed golfersystem’ that achieves maximum time away from bunkers, poison ivy, water hazards and thwacking the sides of houses. The fact that no payment for mistakes is already forcing the DMCB to do this already will go unmentioned.

The American Medical Association

Has the DMCB mentioned that it is a proud member? That storied organization promises to help its members avoid readmissions and reduce unnecessary utilization of spine surgery, percutaneous coronary interventions, C sections, treatment of sinusitis, imaging studies as well as increase medication reconciliations.

The Country Club point of view? The DMCB swears on it's AMA membership card to take out the trash, lift the seat, snore less, sit through chick flicks and listen attentively whenever the spouse has something important to share. It really means it this time. Really.


The DMCB skipped this one. Whatever the merits, DMCB spouse is too suspicious to accept any of it.


This health care workers’ union believes ‘realignment’ can also mean the regulated ‘right-sized’ expansion of any part of the industry that will hire more workers outside of the hospital, such as chronic care settings, the home and community health teams. That is a win-win, assuming that adequate patient to caretaker ratios are maintained with living wage salaries and benefits. Why not? This is the only part of the economy that is adding jobs.

The Country Club point of view? In the spirit of populism, the DMCB agrees that it should not only join a country club but look for one with a pool, wine tastings and a steam room. It will also have its clubs cleaned regularly, visit the Pro Shop and tip generously. These additional services are certain to inject additional value into the DMCB’s golfing experience and are the right thing to do for the economy.

As you may surmise, the DMCB is doubtful. Other than the AMA’s flight of fancy, the initiatives described above fall into one of two categories: 1) spend on one sector now and other sectors will cooperate and accept reductions in revenue, or 2) reduce costs in one sector now to the benefit of that sector, which is always seeking greater efficiencies to the benefit of its bottom line anyway. None are likely to meaningfully make it upstream to the patient-consumer.

Senator Grassley shares the DMCB's skepticism. So should the other members of Congress, unless, of course, they need any argument they can use to get a bill passed.

As for it’s country club travails, the prognosis of winning over the spouse is likewise quite poor.

That doesn't mean we can't try, right?

No comments: