Oncologists being forced out of private practice

Excerpted from "Private Oncologists Being Forced Out, Leaving Patients to Face Higher Bills," The New York Times. November 23, 2014 — When Dr. Jeffery Ward, a cancer specialist, and his partners sold their private practice to the Swedish Medical Center in Seattle, the hospital built them a new office suite 50 yards from the old place. The practice was bigger, but Dr. Ward saw the same patients and provided chemotherapy just like before. On the surface, nothing had changed but the setting.

But there was one big difference. Treatments suddenly cost more, with higher co-payments for patients and higher bills for insurers. Because of quirks in the payment system, patients and their insurers pay hospitals and their doctors about twice what they pay independent oncologists for administering cancer treatments.

There also was a hidden difference — the money made from the drugs themselves. Swedish Medical Center, like many others, participates in a federal program that lets it purchase these drugs for about half what private practice doctors pay, greatly increasing profits. Oncologists like Dr. Ward say the reason they are being forced to sell or close their practices is because insurers have severely reduced payments to them and because the drugs they buy and sell to patients are now so expensive.

It raises questions about whether independent doctors, squeezed by finances, might be swayed to use drugs that give them greater profits or treat poorer patients differently than those who are better insured. Health care economists say they have little data on how the costs and profits from selling chemotherapy drugs are affecting patient care. Doctors are constantly reminded, though, of how much they can make if they buy more of a company’s drug.

While individual oncologists deny choosing treatments that provide them with the greatest profit, Dr. Kanti Rai, a cancer specialist at North Shore-Long Island Jewish Cancer Center, said it would be foolish to believe financial considerations never influence doctors’ choices of drugs. “Sometimes hidden in such choices — and many times not so hidden — are considerations of what also might be financially more profitable,” he said.

Commentary

CMDA Past President and Oncologist Al Weir, MD: “As Christian healthcare professionals, even as we care for those who suffer most, we are caught up in questions of motive and profit. Kolata’s article is quite accurate regarding system changes and finances in oncology. Hospitals are buying oncology practices rapidly on a large scale. Oncologists are fleeing toward hospital ownership as a place of financial refuge from falling incomes. Profits are higher for hospitals than for private doctors. Patients are paying higher copays. Some uninsured are receiving better care. And most of us as healthcare professionals just want to settle into the new systems as we treat individual patients with good science and compassion, as we did before.

“Biblically, I do not know how much profit healthcare professionals should make in caring for the suffering---I have made such profit most of my career and have probably made too much. I do know that we must weigh our profits against the financial suffering we add to our patients' physical sufferings. I do know that we must care for those who cannot afford the standard cost of care, even if we sacrifice to do so. I do know that we are not only responsible for the economic suffering of each individual patient, but also for the suffering caused as we accept system changes. We have a voice; and within these system changes, we, as Christian healthcare professionals, must speak out for the welfare of all patients, just as if they were telling us their individual stories in our own exam rooms.”

Resources

Professionalism in Peril – Part 2: Unjust Scales in Healthcare by Gene Rudd, MD
The Changing Role of the Doctor by Richard A. Swenson, MD
CMDA’s Professionalism Ethics Statement

Study shows therapy reduces suicide

Excerpted from “Study discovers a simple but powerful way to reduce suicide,” Fox News. November 24, 2014 — Talk therapy is a simple but powerful way to stop people at high risk of suicide from harming themselves, according to new research. In a study published in the Lancet Psychiatry journal, researchers who tracked tens of thousands of Danes over an 18-year period found that suicides were down 26 percent over a five-year period among people who had attempted suicide and received talking therapy sessions at a suicide prevention clinic, compared to those sent home with no treatment, the BBC reports.

In the first year, those who received talk therapy were not only 27 percent less likely to attempt suicide again, they were 38 percent less likely to die of any cause—and the positive effects could still be seen more than a decade later.

The researchers say the study is the first solid evidence "that psychosocial treatment—which provides support, not medication—is able to prevent suicide in a group at high risk of dying by suicide." A study co-author tells Bloomberg that even though previous studies showed that one in six people who survive a suicide attempt go on to harm themselves again within a year, many suicide survivors who don't require hospitalization for a mental illness are simply sent home without being referred to a counselor.

The researchers, who say the study reinforces the fact that it's "very important to offer support for people who have attempted suicide," plan follow-up studies to determine which kinds of therapy work best.

Commentary

Founder, Executive Director and Psychiatrist at Lighthouse Network Karl Benzio, MD: “God has blessed us with tremendous scientific advancements, leading to some incredibly helpful psychotropic medications. But in my 25 years of prescribing most of them, none of these medications are curative of any behavioral health issue, but rather they only provide symptom management. As this article nicely shows, the more potentially curative intervention for behavioral health struggles is talk therapy specifically aimed at helping an individual see their life circumstances more accurately, then respond with better decisions. Godly decision-making skills, as Solomon wished for, is the most important skill to master because decision-making is the exercise for, or what strengthens, the brain circuitry. The Bible tells us in Romans 12:1-2 and 2 Corinthians 10:4-6, Godly decision-making actually renews the mind and is our divinely powerful weapon. Many studies are now validating this principle, showing psychotherapy is a neurobiological intervention.

“Contrary to evolution mentality, the human condition is still fragile, decaying and suffering. Even in this great scientific era, suicide is the second leading cause of death in the U.S. when counting unreported and passive suicides. Some say Freud was the father of modern psychiatry, but Jesus was the first psychiatrist, starting the modern behavioral health revolution 2,000 years ago with His radical teachings and life example that show us how to make healthy life management decisions to live the abundant life (John 10:10) and ultimately transform our mind.

“Our calling is to continue what Jesus started. So when you see a patient in clinical practice in any circumstance, assume they’re all broken and struggling psychologically to some extent. Ask about life, stress, satisfaction, fulfillment and goal achievement, and see what responses they have, especially if their presenting symptoms might have some stress or psychological contributing factors. Then be a lighthouse guiding them to God’s peace and transformation using some basic counselor/discipling skills and referring them if more professional guidance is needed.”

Resources

A Relentless Hope: Surviving the Storm of Teen Depression
CMDA’s Psychiatry Section
CMDA’s Suicide Ethics Statement

Women hold egg freezing parties

Excerpted from “For women in tech, egg freezing parties are new post-work event,” SFGate. November 10, 2014 — In Silicon Valley, where many tech employees put in long hours, Dr. Aimee Eyvazzadeh wants women to think about freezing their eggs — after work, and over drinks. The fertility expert is hosting three informational events this week, called egg freezing parties, at restaurants in the Bay Area. Over wine and appetizers, a small group of women will learn more about the egg freezing process and there will be experts to help with any questions.

Eyvazzadeh, who calls herself “The Egg Whisperer,” is jumping on growing interest in preserving eggs in Silicon Valley, as some tech companies have decided to make the procedure a standard health benefit for a young workforce that is faced with the decision on whether to delay parenthood.

More tech companies are offering perks for parenthood in order to keep employees happy. Facebook already covers up to $20,000 for several procedures, including egg freezing, and also offers other benefits for parents, including giving $4,000 in “baby cash” for each child born. Meanwhile, Apple plans to include egg freezing and storage as part of items covered by its health insurance policy next year.

“They are bringing a lot of these women who are graduating from college with very high level coding degrees and they really want them to work … during their younger years, knowing full well that once they get a family, the pressure on them are very different,” said Tim Bajarin, president of advisory services firm Creative Strategies. “What this does is it gives these women another level of choice.”

Alec Levenson, a senior research scientist and labor economist at USC’s Marshall School of Business, called the egg freezing parties “innovative.” “It’s another example of what marketers have always known,” Levenson said. “If you can get people to refer something by word of mouth to friends and family, it’s a much more effective marketing method than trying to do something through general advertising.”

Commentary

Medical Director for the National Embryo Donation Center Jeffrey Keenan, MD: “While egg freezing is medically indicated in limited situations, such as prior to chemotherapy or pelvic radiation in women who desire to maintain their fertility, marketing this service to women in their 20s who are in good health is inappropriate, in my opinion. I disagree with Dr. Eyvazzadeh, that this is just ‘raising awareness.’ I believe throwing ‘egg freezing parties’ is done to raise doubt, not awareness, in a group of people who are typically unsure of exactly what their life will look like in 10 or 20 years. Once doubt has been raised, and especially if your employer pays for it, it’s an easy jump to freeze eggs ‘just in case.’

“That translates into $15,000 for this physician’s practice and some good public relations. Profit and PR are often good things. But the problem with that approach is the great majority of women will never need or use those frozen eggs for a variety of reasons.

“There is a better approach. For younger women who have anxiety about their chances of eventually having a child, we offer a ‘fertility checkup’ to determine her relative fertility compared with her peer group. Then, we discuss her relational status, when she thinks she would like to conceive and how many children she’d like to have before even mentioning an expensive, invasive and (usually) unnecessary procedure like freezing eggs.

“As for the Silicon Valley companies that are offering this as part of employees’ health plans, I think the analyst in the article said it best—they are doing it because ‘once they have a family, the pressures on them are very different.’ In other words, the companies are doing this out of self-interest, although it is cleverly disguised as ‘increasing diversity in the workforce.’”

Resources

Assisted Reproductive Technology Ethics Statement
Dr. Jeff Keenan’s Interview about Egg Freezing Options
National Embryo Donation Center