Medicare Advantage ‘squandering billions’: MedCity Morning Read, Dec. 11, 2009

Highlights of the interesting and important from the world of health care:

Squandering billions: Private insurers in the Medicare Advantage program are “squandering billions” each year on overhead expenses like marketing, executive bonuses and other corporate costs, according to House Democrats. The report comes as Democrats propose cutting nearly $120 billion over the next decade from Medicare Advantage, a program in which seniors receive coverage from private insurers instead of Medicare’s traditional fee-for-service coverage.

Medicare Advantage plans spend less than 85 percent of revenues on patient care, unlike traditional Medicare, in which 98 percent of costs are spent on medical care, according to the report. If that’s true, why does Medicare Advantage even exist?

The health insurance lobbying group retorts that Medicare Advantage plans offer more comprehensive care, such as care coordination and wellness programs, than traditional Medicare. Medicare Advantage plans were created in the 1970s to cut Medicare costs, according to the Washington Post. If that’s true, then isn’t the Medicare Advantage program a failure that has done more to pad insurers’ profits than help patients?

Health overhaul myths: Marketwatch takes a stab at debunking what it calls “the five biggest myths about health reform,” with some of the refutations more convincing than others. It’s a worthwhile endeavor to attempt to refute the assertion that a “government takeover” of health care will ensue, though one suspects that many overhaul opponents will refuse to believe even that most obvious of points.

The column tackles the “myth” that reform attempts do “nothing” to tackle cost control, but the writer’s attempt seems more a question of semantics. Sure, the proposed bills will do “something” in an attempt to control costs, but there seems to be little doubt that the bills won’t do enough.

Putting sexy back into primary care: Cardiologist, internist and blogger Dr. Wes asks how to put the “sexy” back into primary care. With salaries far lower than specialists, annoying paperwork and constant pressure on reimbursements from insurers and Medicare, primary care is by far the least attractive option for young doctors. Those realities have resulted in a much-publicized primary care shortage. Yet primary care’s emphasis on prevention makes physicians who practice that brand of medicine arguably the most important cog in the U.S. health system.

So how do we fix the problem? Dr. Wes offers no specifics, but does provide this general guideline, “What’s sexy to doctors is using independence and entrepreneurism in medicine for the patient’s benefit. .. And unless our legislators get that, primary care will go the way of the dinosaurs and the great paucity of care providers imposed by bureaucratic doctrine, will continue unabated.”

Why doctors goof: U.S. News and World Report has published an interesting feature on why doctors sometime misdiagnoses patients’ ailments. Misdiagnoses lead to an astounding 40,000 to 80,000 hospital deaths every year, according to the report. Obviously, there’s plenty of reasons why misdiagnoses happen, including financial pressure on physicians to increase patient volume, but most misdiagnoses can be chalked up to biases in doctors’ thinking. Somewhat surprisingly, misdiagnoses rarely result from gaps in a physician’s clinical knowledge, according to the report.

Besides relying on first impressions, physicians often put too much stock in their past experience—overdiagnosing tumors, say, because they missed one once. Or, instead of trusting their instincts, they defer to a more experienced colleague or to the adage drummed into them as medical students: “When you hear hoofbeats, think horses, not zebras.” Result: They miss the zebra.