Overview Physician Fee Schedule Look-up

Overview Physician Fee Schedule Look-up

I didn't know this existed!

This allows you to look up reimbursement schedules by region and state for Medicare.

Have fun!

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Dartmouth Atlas of Health Care: Regional Disparity in Medicare Spending - Interactives - Quality/Equality newsroom - Quality/Equality - RWJF

Dartmouth Atlas of Health Care: Regional Disparity in Medicare Spending - Interactives - Quality/Equality newsroom - Quality/Equality - RWJF

The above link takes youto the interactive map that is kind of cool to look at and comare a few regions to see where yours falls.

The actual NEJM article is here. And here is the substantive part of the article (for me, anyway):

What's going on? It is highly unlikely that these differences in growth could be explained by differences in health. Marked regional differences in spending remain after careful adjustment for health, and there is no evidence that health is decaying more rapidly in Miami than in Salem.

The variations allow us to rule out two overly simplistic explanations for spending growth. First, "technology" is clearly an insufficient explanation: residents of all U.S. regions have access to the same technology, and it is implausible that physicians in the regions with slower spending growth are consciously denying their patients needed care. Indeed, evidence suggests that the quality of care and health outcomes are better in lower-spending regions and that there have been no greater gains in survival in regions with greater spending growth.1 Second, it is difficult to blame regional differences entirely on the current payment system, since all our evidence on regional growth comes from populations in the fee-for-service system. Other research has emphasized the role of managed care in moderating the growth of costs,2 but this story cannot explain the rapid growth in Miami, where roughly half of Medicare enrollees are covered by Medicare Advantage plans.

The causes must therefore lie in how physicians and others respond to the vailability of technology, capital, and other resources in the context of the fee-for-service payment system. A recent study by researchers in our group provides further insight.3 Using clinical vignettes to present standardized patient care scenarios to physicians throughout the country, the researchers found that physicians in high- and low-spending regions were about equally likely to recommend specific clinical
interventions when the supporting evidence was strong. Those in higher-spending
regions, however, were much more likely than those in lower-spending regions to
recommend discretionary services, such as referral to a subspecialist for typical gastroesophageal reflux or stable angina or, in another vignette, hospital admission for an 85-year-old patient with an exacerbation of end-stage congestive heart failure. And they were three times as likely to admit the latter patient directly to an intensive care unit and 30% less likely to discuss palliative care with the patient and family. Differences in the propensity to intervene in such gray areas of decision making were highly correlated with regional differences in per capita spending.

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EzraKlein Archive | OBAMA'S HEALTH CARE PLAN EXPECTS AN INDIVIDUAL MANDATE.

EzraKlein Archive The American Prospect:

"Administration officials have been very clear on what the inclusion of 'universality' is meant to communicate to Congress. As one senior member of the health team said to me, '[The plan] will cover everybody. And I don't see how you cover everybody without an individual mandate.' That language almost precisely echoes what Senate Finance Chairman Max Baucus said in an interview last summer. 'I don’t see how you can get meaningful universal coverage without a mandate,' he told me. Last fall, he included an individual mandate in the first draft of his health care plan.

"The administration's strategy brings them into alignment with senators like Max Baucus. Though they're not proposing an individual mandate in the budget, they are asking Congress to fulfill an objective that they expect will result in Congress proposing an individual mandate. And despite the controversy over the individual mandate in the campaign, they will support it. That, after all, is how you cover everybody."


While I favor a single payer system as the best solution, it doesn't take a rocket scientist (or Ezra Klein) to see where the winds are blowing.

I have become comfortable with this approach. Although mandates have not worked out as well as we'd like in Massachusetts, it is hard to argue that they have not worked in Switzerland, Germany, Japan and other countries. I would argue that the chief differences are two:
1.) Spending enough money to actually give everyone a comprehensive benefits package (think Medicare, not Medicaid)
2.) Serious regulation of private insurers so that they cannot cherry-pick, deny, drop, obfuscate, etc

If we spend enough money in some private-public mix and if we regulate the insurers so they function more like the contractors who cut the checks for Medicare (the regional "carriers") and we subsidize those who cannot afford health care or insurance, we may not have single payer, but we will at least have a truly universal, fair, system.

AND THEN, if we still think we need to, we can work on transitioning to a true single payer system.

OK, let me have it.

Cheers,

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THE ROSTER | Insurance Company Rules

THE ROSTER Insurance Company Rules

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America's Agenda Health Care Summit Conversations

America's Agenda Health Care Summit Conversations

A collection of videos, that I have not yet reviewed, but put here for now as a bookmark.

Good line up of speakers, at least.

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Poll Shows Strong Support for Obama Health Care Reforms - US News and World Report

Poll Shows Strong Support for Obama Health Care Reforms - US News and World Report:

"The poll shows that as Americans learn more about Obama's anticipated reforms, they seem better able to make up their mind about them -- either pro or con. For example, 62 percent of those surveyed who said they knew 'a lot' about the new president's ideas expressed support for the initiatives, with 36 percent opposed and only 2 percent saying they were 'not sure.' Among those who said they knew nothing about the Obama proposals, 66 percent remained unsure, 23 percent were supportive, and 11 percent opposed.

"Some other key findings:

"A majority of respondents said the reforms, if carried out, would improve the health care system. Sixty-one percent felt reforms would deliver adequate health insurance to more people, and 54 percent thought health care would be made more cost effective. But a fifth of respondents thought the changes would make the quality of medical care worse, not better.

"Support for the proposals did not vary significantly based on income. Fifty percent of people making between $15,000 and $25,000 annually approved of the Obama plan, compared to 51 percent of those making $50,000 or more. But the gap widened as respondents looked at specific issues, such as the plan's ability to boost the quality of care or strengthen the economy.

"Predictably, support split along party lines, with three-quarters of Democrats supporting Obama's overall plan, compared to 26 percent of Republicans. Many Republicans appeared to favor specific elements of the plan, however. For example, 70 percent supported the notion of having Medicare negotiate drug prices, and more than half (53 percent) agreed with offering subsidies to low-income families to ensure universal health coverage"

The full report is here.

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Tire rims and Anthrax from "Balloon Juice "

Balloon Juice » Blog Archive » You’ll Never Get This 21 Minutes Of Your Life Back:

"I really don’t understand how bipartisanship is ever going to work when one of the parties is insane. Imagine trying to negotiate an agreement on dinner plans with your date, and you suggest Italian and she states her preference would be a meal of tire rims and anthrax. If you can figure out a way to split the difference there and find a meal you will both enjoy, you can probably figure out how bipartisanship is going to work the next few years."

Sorry, but I had to post this, because I'm using it as mental shorthand all the time, and I just heard it last week.

Someone also posted this adjustment, which I also like:

"Imagine trying to negotiate an agreement on dinner plans with your date, and you suggest Italian and she states her preference [would be a meal of tire rims and anthrax] to give the rich guy at the next table a tax break, hoping he buys your dinner."

I am more than a little concerned we'll have the same feeling as we break out the Chianti for the health care reform debate...

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