I spent last weekend in Las Vegas losing money with some childhood friends so I missed my post. I’m a chintzy gambler; I like to play but hate losing (which I’m expert at) so each year I venture less of the embarrassingly small sum I set aside. This is a good thing, because simple math indicates that revenues = income – gambling losses – reduction in salary, and physician uncertainty about the third variable has been blossoming for the past few years. My trip next year may hang in the balance. A couple of synopses from recent ACC New Digest posts give perspective:

The Washington Post (10/24, MacGillis) reported, “The health-care law of 2010 is, as Vice President Biden put it, a ‘big [expletive] deal,'” which “sets us on the road to universal health insurance.” Yet, “the Democrats’ effort to sell the law to the public may be undermined by what even some ardent supporters consider its biggest shortfall. The overhaul left virtually untouched one big element of our health-care dilemma: the price problem. Simply put, Americans pay much more for each bit of care — tests, procedures, hospital stays, drugs, devices — than people in other rich nations.”

American Medical News (10/25, Berry) reports that “physician payment reform — intended to be a step up from terms such as ‘pay-for-performance’ — is gaining traction as more authorities in the health industry declare that no improvements in quality or costs will come without fundamentally changing how doctors are reimbursed.” Earlier this month, the National Committee of Quality Assurance’s (NCQA) annual State of Health Care Quality report, “which looked at claims data from more than 1,000 health plans representing 118 million Americans, declared that spending more money on healthcare did not automatically lead to better health.” However, “the NCQA does not lay out a specific strategy on using physician payment as a way to increase quality. Instead, the report noted that a nuanced approach was needed to find a way to deliver healthcare efficiently — and well.”

Don’t get me wrong—those of you who have read prior posts know that I agree that fundamental changes need to occur to reverse the health care crisis, and reducing our expenditures without reducing the quality of care can be achieved. I’m just concerned that the threat of the “slash-and-burn” approach to cost reduction that has been the norm for several years will continue. We need more than vapid remarks about what needs to be done. We need an intelligent, “specific strategy.” I’m waiting. And the economy of Nevada hinges on the outcome.


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