tag:blogger.com,1999:blog-7722294029877743408.post2574608342891454104..comments2024-03-13T21:55:29.791-07:00Comments on The Weinmann Report - politicsofhealthcare.com: OBAMACARE NEEDS INSTANT REVISION by Robert L. Weinmann, MDRobert Weinmannhttp://www.blogger.com/profile/06207543223165842066noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-7722294029877743408.post-18061778469459112942015-10-29T20:43:43.079-07:002015-10-29T20:43:43.079-07:00This comment has been removed by a blog administrator.艾丰https://www.blogger.com/profile/04154230348620451165noreply@blogger.comtag:blogger.com,1999:blog-7722294029877743408.post-17646112497826178892011-03-08T20:18:22.747-08:002011-03-08T20:18:22.747-08:00Comment on Dolori Finem's observation ... well...Comment on Dolori Finem's observation ... well said! My point about the 12 hour course is that the non-California state licensed doctors aren't responsible to the California Medical Board since they're not licensed in California. The 12 hour course at least makes sure that the examinees know the relevant law in California. <br />Doctors who don't take this course cannot be held responsible to the medical boards in their own states since those states don't have jurisdiction in California. So, to whom are the non-licensed doctors responsible? The answer is they're responsible to their employers, the insurance companies.Robert Weinmannhttps://www.blogger.com/profile/06207543223165842066noreply@blogger.comtag:blogger.com,1999:blog-7722294029877743408.post-19386469698610091222010-12-12T23:19:39.076-08:002010-12-12T23:19:39.076-08:00COMMENT ON GARRET'S COMMENT
I agree, Garret, ...COMMENT ON GARRET'S COMMENT<br /><br />I agree, Garret, that a 12 hour course in pain management may not improve patient outcomes, but it's enough to make sure that California doctors doing pain management know about California law. Licensure makes sure that so-called peer reviewers run the same risks as primary treating physicians and are equally subject to California's medical board. Treating doctors' wrongful decisions are subject to licensure review. Non-California licensed doctors don't run this risk -- they're not subject to the California board or even their own state boards because they don't have jurisdiction in California. <br /><br />As for the specialty title, that's a problem because major boards also have sub-boards with overlapping expertise, e.g., more than one major board has a sub-specialty board in pain medicine or pain management. <br /><br />You're right on target in pointing out that there's more financial incentive to denying care than there is to authorizing care. On a national level, that's why there's an IPAB in the ACA ("Obamacare"). The idea is create an up-front sophisticated denial and rationing system. <br /><br />"Medical Red-lining, Economic Credentials for Physicians," San Francisco Examiner, 12 Jan 1996, reprinted in the Congressional Record, v. 144, # 118, 9 Sept 1998, may interest you.<br /><br />Your overall point that "it is more profitable to deny" goes smack to the financial heart of the matter. That's where the fight should be.<br /><br />Thanks for your thoughtful comment,<br /><br />robert L. weinmann, MD, EditorRobert Weinmannhttps://www.blogger.com/profile/06207543223165842066noreply@blogger.comtag:blogger.com,1999:blog-7722294029877743408.post-7662775089092777972010-12-12T14:14:45.979-08:002010-12-12T14:14:45.979-08:00Perhaps I'm wrong, but in my limited experienc...Perhaps I'm wrong, but in my limited experience thus far it seems that the primary issue with utilization review is incentivization. That is, third party UR firms are capitalist enterprises with reimbursement schemes directly tied to denial rates. If there really was pure objectivity without financial impetus then the system may very well work. However, as soon as it becomes more profitable to deny, either through direct increases in payment or by additional throughput as reward for decreased authorization, any potential legitimacy is lost. <br /><br />I have to disagree with your contention that in-state medical licensure improves UR outcomes. Any notion that a 12 hour review course in pain management provides improved UR objectivity is dubious at best, and I can tell you that in my practice the denial rates, denial rationale and peer-to-peer discussion are no better with in state UR. A far larger issue is the review process that allows specialty specific decision making to be carried out by physicians without subspecialty training. Throw in the type of politicking to which you refer and the entire system may very well grind to a halt, at least from a patient advocacy standpoint.Anonymoushttps://www.blogger.com/profile/15644240240659699432noreply@blogger.comtag:blogger.com,1999:blog-7722294029877743408.post-55789417788566762010-12-12T10:39:06.758-08:002010-12-12T10:39:06.758-08:00Perhaps I'm wrong, but in my limited experienc...Perhaps I'm wrong, but in my limited experience thus far it seems that the primary issue with utilization review is incentivization. That is, third party UR firms are capitalist enterprises with reimbursement schemes directly tied to denial rates. If there really was pure objectivity without financial impetus then the system may very well work. However, as soon as it becomes more profitable to deny, either through direct increases in payment or by additional throughput as reward for decreased authorization, any potential legitimacy is lost. <br /><br />I do, however, have to disagree with your contention that in-state medical licensure improves UR outcomes. Any notion that a 12 hour review course in pain management provides improved UR objectivity is dubious at best, and I can tell you that in my pain practice the denial rates, denial rationale and peer-to-peer discussion are no better with in state UR. A far larger issue is the review process that allows specialty specific decision making to be carried out by physicians without subspecialty training. Throw in the type of politicking to which you refer and the entire system may very well grind to a halt, at least from a patient advocacy standpoint.Dolori Finemhttps://www.blogger.com/profile/00254067538961938269noreply@blogger.comtag:blogger.com,1999:blog-7722294029877743408.post-62988142110465780282010-12-11T11:54:57.714-08:002010-12-11T11:54:57.714-08:00COMMENT ON THE COMMENTS
The IPAB in the ACA, Sect...COMMENT ON THE COMMENTS<br /><br />The IPAB in the ACA, Section 10320, will require implementation by rule making -- that's the process by which statute may be enforced, implemented, or eviscerated.<br /><br />In the California examples in our earlier reports, we describeD how Utilization Review got turned upside down by a decision by the Office of Administrative Law which decided that in-state medical licensure wasn't necessary for utilization review. <br /><br />I appreciate Bradley Hennenfent's succinct approval and Dolori Finem's detailed discussion. The trouble is that IPAB appointees will be chosen by politicians, not by "an objective panel of trained professionals." <br /><br />Robert L. Weinmann, MD, EditorRobert Weinmannhttps://www.blogger.com/profile/06207543223165842066noreply@blogger.comtag:blogger.com,1999:blog-7722294029877743408.post-90291409565948404282010-12-10T11:10:26.585-08:002010-12-10T11:10:26.585-08:00I'll preface the following diatribe with a sin...I'll preface the following diatribe with a single caveat; I hate utilization review. Pure and simple. I've been out of fellowship and practicing now for less than six months and I've already concluded that whatever logic may have substantiated the initiation of this process has been lost to an all too nihilistic and antagonistic endeavor. <br /><br />That stated, the statistics regarding US health care remain valid. Two and a half trillion dollars in total, over 17% of GDP, now over $8,000 per capita, for a system that still fails to treat an astonishingly vast population. The pending insolvency of Medicare should serve as sufficient impetus for change, and the final realization that health care, and more pertinently health care spending, is a finite resource. As such, it must be rationed. <br /><br />I've been clear about utilization review, but I'm also well aware of the dangers of continued cost escalation, to the field, to the people, to the economy. An objective panel of trained professionals, preferably specialty specific, trusted to oversee medicine's all to often rampant over utilization of services seems as legitimate an answer as I've heard thus far. Do I trust the federal government to develop this? No. Do I put faith in politicians more concerned with their own re-election campaigns than the good of the country? No. But it's at least a topic worth discussing, and vastly superior to simply putting off the difficult decisions until the next political term.Dolori Finemhttps://www.blogger.com/profile/00254067538961938269noreply@blogger.comtag:blogger.com,1999:blog-7722294029877743408.post-38622981561872115342010-12-02T15:35:01.395-08:002010-12-02T15:35:01.395-08:00Excellent article.Excellent article.BradMDhttps://www.blogger.com/profile/06530664817047555773noreply@blogger.com