variation in medicare spending: some regions already spend at canadian level
DESCRIPTION
Variation in Medicare Spending: Some Regions Already Spend at Canadian Level. Overuse of Cardiac Stents. 15% of all stent procedures are appropriate - for acute heart problems (ACS) But, 85% of stents are done for stable heart problems, where no better than simple drugs. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/1.jpg)
![Page 2: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/2.jpg)
![Page 3: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/3.jpg)
![Page 4: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/4.jpg)
![Page 5: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/5.jpg)
Variation in Medicare Spending:Some Regions Already Spend at Canadian Level
![Page 6: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/6.jpg)
Overuse of Cardiac Overuse of Cardiac Stents Stents 15% of all stent procedures are appropriate - 15% of all stent procedures are appropriate -
for acute heart problems (ACS)for acute heart problems (ACS) But, 85% of stents are done for stable heart But, 85% of stents are done for stable heart
problems, where no better than simple drugs.problems, where no better than simple drugs. Patients treated only with drugs are 11% Patients treated only with drugs are 11%
more likely to eventually need a procedure. more likely to eventually need a procedure.
Hence, 62-75% of PCIs are unnecessary, Hence, 62-75% of PCIs are unnecessary, costing $13- 15 billion/year (of the total costing $13- 15 billion/year (of the total $20,000 spent on stents). $20,000 spent on stents).
![Page 7: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/7.jpg)
![Page 8: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/8.jpg)
![Page 9: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/9.jpg)
![Page 10: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/10.jpg)
![Page 11: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/11.jpg)
Quality of Care Slightly Better in Canada Than U.S.
A Meta-Analysis of Patients Treated for Same Illnesses
(U.S. Studies Included Mostly Insured Patients)
Source: Guyatt et al, Open Medicine, April 19, 2007
![Page 12: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/12.jpg)
![Page 13: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/13.jpg)
![Page 14: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/14.jpg)
![Page 15: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/15.jpg)
![Page 16: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/16.jpg)
![Page 17: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/17.jpg)
![Page 18: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/18.jpg)
![Page 19: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/19.jpg)
For-Profit Hospitals’ Death Rates are 2% HigherSource: CMAJ 2002;166:1399
![Page 20: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/20.jpg)
For-Profit Hospitals Cost 19% MoreSource: CMAJ 2004;170:1817
![Page 21: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/21.jpg)
For-Profit Dialysis Clinics’ Death Rates are 9% Higher
Source: JAMA 2002;288:2449
![Page 22: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/22.jpg)
New Bad Ideas from the New Bad Ideas from the Private Insurance Private Insurance IndustryIndustry Consumer-directed care = skimpy Consumer-directed care = skimpy
coveragecoverage Individual mandates like Massachusetts Individual mandates like Massachusetts
(force the uninsured to buy “skimpy (force the uninsured to buy “skimpy coverage”)coverage”)
Corporate disease management – replace Corporate disease management – replace primary care with firms that manage care primary care with firms that manage care for patients with diabetes, heart failure, for patients with diabetes, heart failure, etc.etc.
Let private insurers compete with Let private insurers compete with Medicare or similar programMedicare or similar program
![Page 23: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/23.jpg)
![Page 24: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/24.jpg)
![Page 25: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/25.jpg)
Actual copy of internal memo from VP for Benefits to Walmart’s Board of Diectors, 2005
Walmart’s Plan: Attract Young, Healthy Workers by CDHP
+ Mandatory Physical Exertion
![Page 26: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/26.jpg)
Individual MandatesIndividual Mandates
MA lawMA law Proposed in NY and ILProposed in NY and IL Component of plans by Edwards, Component of plans by Edwards,
Obama and othersObama and others
![Page 27: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/27.jpg)
Crimes and Punishments in Crimes and Punishments in MassachusettsMassachusetts## The CrimeThe Crime The The
FineFine
11 Violation of Child Labor LawsViolation of Child Labor Laws $50$50
22 Employers Failing to Partially Employers Failing to Partially Subsidize a Poor Health Plan for Subsidize a Poor Health Plan for WorkersWorkers
$295$295
33 Illegal Sale of Firearms, First OffenseIllegal Sale of Firearms, First Offense $500 max.$500 max.
44 Driving Under the Influence, First Driving Under the Influence, First OffenseOffense
$500 min.$500 min.
55 Domestic AssaultDomestic Assault $1000 $1000 max.max.
66 Cruelty to or Malicious Killing of Cruelty to or Malicious Killing of AnimalsAnimals
$1000 $1000 max.max.
77 Communication of a Terrorist ThreatCommunication of a Terrorist Threat $1000 $1000 min.min.
88 Being Uninsured In MassachusettsBeing Uninsured In Massachusetts ~ $2000~ $2000
![Page 28: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/28.jpg)
Corporate Disease Corporate Disease Management ProgramsManagement Programs No evidence that any disease No evidence that any disease
management program lowers costs.management program lowers costs.
Fair evidence that non-profit disease Fair evidence that non-profit disease management programs led by health management programs led by health professionals improve quality. professionals improve quality.
![Page 29: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/29.jpg)
Private insurers Private insurers competing with competing with MedicareMedicare Edwards and Obama proposalEdwards and Obama proposal Already policy within the Already policy within the
Medicare Advantage programMedicare Advantage program
![Page 30: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/30.jpg)
![Page 31: Variation in Medicare Spending: Some Regions Already Spend at Canadian Level](https://reader035.vdocument.in/reader035/viewer/2022081603/56813c60550346895da5e60f/html5/thumbnails/31.jpg)