Medicare payment changes draw fire
Neurologists rip lower test fees
By Chelsea Conaboy
| GLOBE STAFF
NOVEMBER 26, 2012
Neurologists in Boston and nationwide are objecting to a plan that would pay them less for certain diagnostic tests, a change meant to cut Medicare costs and direct more money to primary care physicians whose pay is widely seen as inadequate even before they take on more work under the national health care overhaul.
The neurologists are asking federal regulators to reconsider the plan and argue that the cuts, made under a provision of the Affordable Care Act, could undermine patient care and limit access to neurology services.
The debate highlights the short-term pain and pressure expected from changing the way health care is paid for, a process certain to produce winners and losers.
“This loss of revenue is devastating,” said Dr. Bruce Sigsbee, a neurologist in Rockport, Maine, and president of the American Academy of Neurology. The cuts cause harm not only to the subset of neurologists who perform the tests but to the specialty as a whole, he said.
The tests effectively subsidize other kinds of neurology care that provide less lucrative payments, and specialists said the change could prompt some neurologists and hospitals to see fewer Medicare patients.
In Delhi, a ‘Sand Hill Road’ for Cheap Health Care
By JYOTI PANDE LAVAKARE
You've probably heard of Sand Hill Road, home to Silicon Valley's venture capitalists, who changed the way the tech industry did business. You probably haven't heard of New Delhi's MedTech Row, but the innovators and entrepreneurs who work here are no less ambitious in attempting to transform the health care industry.
Not far from the historic Qutab Minar monument in the Indian capital, a whole ecosystem of health and medical technology innovators and entrepreneurs specializing in "affordable health care" has sprung up. These newcomers are focused on developing technology to provide better health care to poor people and those with limited access to medical services, while, for the most part, making a profit at the same time.
"India is a hotbed of innovation," said Elizabeth Bailey, director of the Consortium for Affordable Medical Technologies, or CAMTech, in a phone interview from Boston. The consortium is planning to set up an "innovation laboratory" to test low-cost medical technology on MedTech Row.
CAMTech's members include the Massachusetts General Hospital, Harvard Medical School, the Medical Electronic Device Realization Center at M.I.T. and Indian research foundations like the Lata Medical Research Foundation and the Vellore Institute of Technology. The aim, Ms. Bailey said, is to find low-cost solutions in collaboration with the people who need them the most. "Ultimately, we would like to help health workers to work smarter and harder," Ms. Bailey said.
MedTech Row is defined geographically by an enclave of the Qutub Institutional Area, which borders the Indian Institute of Technology's biomedical engineering department to the south and the All India Institute of Medical Sciences to the north. Between these venerable Indian institutions, several companies and partnerships have their offices clustered around Jawaharlal Nehru University's campus, with their focal point the offices of the government's Department of Science and Technology.
This is the area where the nonprofit health giants like Program for Appropriate Technology in Health, or PATH, Public Health Foundation, the Michael and Susan Dell Foundation and the Bill and Melinda Gates Foundation have offices.
Partnerships and for-profit companies have also set up shop here. For example, the All India Institute of Medical Sciences, which is likely to be the final testing ground of most of MedTech Row's innovations, is currently also home to the Stanford India Biodesign program, a collaboration of the institute, Stanford University and Delhi's I.I.T. The program is training a new generation of Indian medical technology innovators between Stanford and New Delhi. And the Silicon Valley venture capital firm Sequoia Capital has an office here.
Aiding the Doctor Who Feels Cancer’s Toll
By JANE E. BRODY
The woman was terminally ill with advanced cancer, and the oncologist who had been treating her for three years thought the next step might be to deliver chemotherapy directly to her brain. It was a risky treatment that he knew would not, could not, help her.
When Dr. Diane E. Meier asked what he thought the futile therapy would accomplish, the oncologist replied, "I don't want Judy to think I'm abandoning her."
In a recent interview, Dr. Meier said, "Most physicians have no other strategies, no other arrows in their quiver beyond administering tests and treatments."
"To avoid feeling that they've abandoned their patients, doctors throw procedures at them," she said.
Dr. Meier, a renowned expert on palliative care at Mount Sinai Medical Center in New York, was the keynote speaker this month at the Buddhist Contemplative Care Symposium, organized by the New York Zen Center for Contemplative Care and the Garrison Institute. She described contemplative care as "the discipline of being present, of listening before acting."
"Counter to how the American medical system is structured, which pays for what gets done," she said, "its approach is, 'Don't just do something, stand there.' "
But the idea is not to do just that. Rather, she said, the goal is to "restore the patient to the center of the enterprise."
Under the Affordable Care Act, she said, unnecessary procedures may decline as more doctors are reimbursed for doing what is best for their patients over time, not just for administering tests and treatments. But more could be done if physicians were able to step away from the misperception that everything that can be done should be done.
Dr. Meier's question prompted Judy's doctor to realize that what his patient needed most at the end of her life was not more chemotherapy, but for him to sit down with her, to promise to do his best to keep her comfortable and to be there for the rest of her days.
After 26 years, ‘ideal country doctor’ to stop seeing patients
By Nick Sambides Jr., BDN Staff
Posted Nov. 24, 2012, at 3:09 p.m.
LINCOLN, Maine — Growing up in a home with a doctor’s office in the basement and a country doctor for a father, Noah Nesin was sure of one thing: No way was he going to practice medicine.
Dr. Bourcard Nesin worked 16-hour days at least five days a week. Emergency rooms weren’t prevalent in Maine in the 1960s, so when Nesin wasn’t doing house calls, his patients filled the basement staircase waiting to see him, sometimes until midnight.
“I think I resisted medicine as a boy because everybody asked me all the time if I was going to grow up and be a doctor. I think I just got tired of the question,” Nesin said. “I think as an adolescent, in the ways that you rebel against your parents, I just rebelled against the idea of being exactly what my dad had been.”
Things reversed entirely, Nesin said, when his father approached him during Noah’s junior year in college as the younger Nesin fretted over his decision to study physics.
“He said, ‘You know, you’d make a good doctor,’” Noah Nesin recalled. “That’s the only thing he ever said to me about it, but it must have been powerful, because I began applying to medical school after that.”
Twenty-six years and perhaps 10,000 patients later, Nesin has decided to change careers. He plans in March to leave Health Access Network to take a job in Bangor that he says will allow him to help reshape the way medicine is practiced.
Nesin’s departure marks the end of a medical practice that began with his father in 1953. Nesin’s brother, Joseph, continues as a veterinarian in Chester and their brother Peter is an optician in Belfast.
Several colleagues at HAN said they regret his decision. They describe Nesin as an excellent medical director and unpretentious physician whose expertise, support and gently sarcastic humor will be missed.
“He and Dr. [Stratton] Shannon were the quintessential family doctors in a rural area,” said Christopher Mannari, a physician’s assistant at Health Access. “He is, as is Shannon, the ideal country doctor.”
Nesin “used to deliver babies, he did vasectomies, gynecology, house calls. He still does [house calls] for some of his patients as far as I know,” Mannari added. “Now, people just refer you to a specialist, but for years, these guys [Shannon and Nesin] did everything they possibly could for their patients.”
George Michaud is one of those patients. The 76-year-old Passadumkeag resident was among Bourcard Nesin’s first patients when he began his practice in Howland, delivering Michaud’s son Daniel in 1960 for $27.
“That paid for the hospital and him. Can you imagine that? They were making quite a sacrifice with the job that they do,” Michaud said of the Nesins. “They were both very dedicated.”
Nesin said his new job will allow him to shape the delivery of medical care now to conform with the Patient Protection and Affordable Care Act, which Nesin said he strongly supports. The job will, he said, hopefully change what is the bane of modern American health care — a turnstile medical system that prizes the number of patients seen more than the quality of care delivered.
American medical care, Nesin said, generally flourishes in its treatment of chronic or severe conditions but the 15-minute doctors’ appointment that most facilities shoot for cramps effective care.
Nesin looks forward to tackling that problem, he said, but regrets leaving patients.
No comments:
Post a Comment